Saturday, April 30

Man forced into ambulance ride. But was he kidnapped?

EMS1.com is reporting a Florida man who was transported after a loss of consciousness may sue the agency that transported him.

According to the report, the patient suffered a loss of consciousness and was assisted by neighbors to his home and someone other than the patient dialed 911.

After an assessment, according to the patient, the paramedics determined he was "at risk for a stroke" and needed transport.

Kenneth Rothwell, the patient, states he was told, "It was either go, or you're going to be handcuffed and we're going to take you."

Hang on here a minute folks.

The story does not elaborate WHO said anything about the handcuffs, but a deputy and EMT were at the scene.  Now we have reports of 3 rescuers ("Paramedic" "deputy" and "EMT").  I wonder which one brought up the idea of handcuffs?

 

We have safeguards in place for this kind of situation by way of direct Medical Control.  Whenever I have a high index of suspicion of illness or injury and a patient refuses, I do my best to convince them of what I think is in their best interests.  If that fails I fall back on direct Medical Control to talk to the patient.  If that fails, most times, the MD will instruct me to explain the dangers of staying home to the patient and...wait for it...leave them there.

There is never a threat of "being handcuffed and we're going to take you."  That should NEVER be an option.  The urban myth that is patient kidnapping is being supported by poor decision making based on false presumptions.  I can only imagine that the deputy who made the hand cuff comments (unconfirmed) had no intention of placing Mr Rothwell under arrest for passing out.  I'll have to confirm with Motorcop that is not an arrestable offense.

 

Point is that Mr Rothwell has a very good argument against whoever told him he "had" to go, either willingly or in cuffs.  THAT is the part that bothers me about all this.  That and the fact Mr Rothwell is required to make health care decisions based on out of pocket expenses, but that's another issue entirely.

 

Comments will surface soon about foolish EMTs or that this is a good reason EMTs and Paramedics should not be making refusal referrals pre-hospital, but this is EXACTLY what Mr Rothwell needed.  BLS before ALS failed Mr Rothwell.  A well trained Paramedic could have offered Mr Rothwell a calm comfortable ride in his first response vehicle, or even to follow him to the local ER if he likes.  Maybe even make an appointment to call or drop by later in the day to check in on him, but we are locked into a 40 year old model that scares our people into transporting every scratch and scrape, tummy and head ache so we don't get sued.

And this is where it gets us.

At the very least, the agency who mislead Mr Rothwell using intimidation in order to remove him from his home against his will is at risk for setting an industry wide precedent and prove the urban myth a reality.

 

Your training exercise for the day:

Was Mr Rothwell, based on the EMS1.com story facts as reported, kidnapped?

Thursday, April 28

A Deep Sigh

He was tired.

So tired.

You could see it in his face and the way he lay on the floor.  The piles of pill bottles of varying contents and varying ages for various afflictions told a story he could not.

His life was all around him.

Tattered edges of sepia toned photographs showed a young child eager to live life.  Grainy greens and yellows share the photo with hints of rust where he and his buddies fought a war far away.  A posed portrait in an oversized neck tie and tuxedo with a beautiful young woman in white, her hairdo giving away their marriage was in the late 50s peaks from around the corner in the hallway.

My thoughts wandered to what he had seen over his years, what he had thought, why he had cried, what he laughed at and remembered above all things.

He was an avid reader, as told by the hundreds of books of varying topic, size and wear on enormous book shelves almost impossibly carried into this small apartment which is in none of the photos.  Clearly this was not where he lived his life, but just where he kept his stuff.

A Navy man, according to the diploma on the wall and class photo adorned with a number of medals, none of them I recognized from all the fancy ceremonies on TV.  A robe sits over the back of his desk chair, as if it lived there during the afternoons waiting for him to put it on to read.

On the desk is an envelope, sealed, with no writing on the outside to tell us where it came from.

The kitchen is immaculate, as is the bathroom and aside from books piled everywhere he kept this little slice of the world clean and organized.

That explains the towel.

For whatever reason, whether a memory from the sepia photographs, a ghost from the war or something more recent, he has taken his own life this morning, just after sunrise.

He lay the robe on the chair as he must have done ten thousand times, got dressed, had breakfast, did the dishes, pulled the revolver from wherever it was tucked away and lay out a large blanket on the floor.

Then, thinking not of himself but we who would find him, he rested down on a pillow, pulled a towel over his head and said goodbye.

The shot was heard by a neighbor who raced to the door to find it unlocked and ajar, we later arrived to confirm what he had already known.

It was over.  He was done.

Tuesday, April 26

It gets to you

A recent call I went on got under my skin.

Not because it was gory, or messy, or challenging or complex, but because of how it made me feel.

Certain runs get under our skin for different reasons.  The cancer patient means more when your father is suffering the same disease.  The motor vehicle collision that much more important soon after your car gets out of the shops.

 

This run involved kids.

 

It was the kind of call that makes you wonder just what some people are thinking.  The kind of situation you see in crazy FBI TV shows where the heroes barge in saving the day then scream "Get me a medic in here!" and the show ends.  But they never show the medics working and later dealing with the situation.

That is why EMS shows rarely succeed.  No one wants to watch a TV show about what I did on this call, what the ambulance and first responding crews saw and felt, nor what the police were describing.  It would not be safe for TV, I think even HBO might take a pass.

No one was hurt.  That's the kicker here.  The usual trauma and scaring from seeing children in pain or suffering was absent, making justifying emotions both at the scene and later difficult.  I was mad, upset, yes UNhappy and I couldn't really say why.

OK, I could, but describing it was not enough to capture everything that was going on there.  So much information had to be collected, organized and regurgitated in some kind of list of events and conditions so that someone in a tiny cubicle months from now could have some brief idea of the scope of the situation.

Searching for a release I considered firing up the blog here and letting it out, but even the simplest of details let free in a post I needed to write to start to deal with my feelings was dangerous.

So I wrote a blog post, of sorts, to myself.  A letter to myself.  By hand.

When was the last time you wrote anything by hand other than a PCR?  There is indeed something powerful about having to write out your thoughts and dwell on certain facts.  Many have reached the point where we type as fast or faster than we could write and sometimes we lose the impact of certain words and phrases.  My hand searched for the way to write certain words I had not in recent memory created using a pen.  I stumbled, more than one word crossed out and replaced either due to a spelling error or a better word coming to mind.  I was two or three sentences behind of my racing thoughts.

I finished it. I read it. Then I shredded it.

The emotion released, my feelings expressed, I was able to sit down and complete the reports necessary for this incident.  And even though some of my observations show my opinions regarding the incident, none of the anger, frustration or shock is in the report.

And that's how it should be.

 

 

Saturday, April 23

the Crossover - Episode 12 - Magical Mustache Ride

The boys are back and earning that itunes explicit tag early in Episode 12! We discuss why Justin thinks dying in a car crash should not be an LODD but something different, Motorcop reminds us about Horizontal Gaze Nystagmus, then pukes and why Justin can't grow a mustache to save anyone's life.

And extra points for naming my horrible impersonation in the opening bit!



Episode 12

Changes

Well gentle readers, you may have noticed a slight change in the blog in the last few days.

OK, a touch more than slight.

Happy Medic is no longer linked into the Fire EMS Blogs Network, but settling in here at the new First Responders Network.

The guys at Fire EMS Blogs invited me in at the very beginning and being a part of their network was awesome. There I was amongst some of the best bloggers out there, my little link popping up on the pages of AmboDriver, FireGeezer, Statter911, Life Under the Lights...the list goes on and on and on. They have added literally dozens of bloggers since the beginning and it was a tough decision to step away.

It turns out the TV and Film industry is suspect when someone else "controls" your content. Even though the FireEMSBlogs folks never once edited, redacted or guided my posting (other than some really great links and suggestions, thanks) the powers that be outside our close knit blogging family saw my blog outside our network as a liability rather than an opportunity.
Countless times I have explained to folks the relationship between me the writer and the guys managing the network, but repeatedly I would get a blank look, a "huh..." and then no word.

So with a number of exciting projects on the horizon, I'm stepping away from FireEMSBlogs and parking my therapy experiment here at FRN. We're not as flashy or dialed in as the old network or EMSBlogs.com, another successful network worth following, but this removes the only road block that has been voiced to us regarding other projects. Projects bigger than my ramblings about annoying clients but, rest assured, you have not seen the last of ol' HM.

The site has changed, both the look and feel, but the crappy content will keep coming. In just a few minutes I'll be adding another edition of the Crossover Podcast and things are right back to normal.

So keep your links to HappyMedic.com pointed right where they need to be, but perhaps check that RSS reader to make sure you have the new feed dialed in. Check the link at the top of the page.

Updates as they come...thanks for sticking around.  And if you think THIS is a big change...

I give you Justin Schorr on bass, Ted Setla on drums and Motorcop on lead guitar!


You ain't seen nothin' yet.

Friday, April 22

Do not adjust your internet

If you can see this too, we are indeed still alive. Everybody hold onto something, this is going to get interesting.

Wednesday, April 20

Fundraiser for Bryan Stow

From a friend:


[caption id="" align="alignleft" width="400" caption="Bryan Stow"]Bryan Stow from Support4Stow.blogspot.com[/caption]


URGENT MESSAGE FROM the BAY AREA EMS COMMUNITY


Paramedic Bryan Stow was severely injured during an altercation at the San Francisco Giants vs. Los Angeles Dodgers Game on Thursday, March 31st. He is in the Intensive Care Unit in L.A. and has two young boys.


Funds will be placed in a Trust for the children and to assist with his family's bills for accommodations and food while they are with him in L.A.


You can also donate via the following methods:


1) Donate directly to his Fundraising Account at Commonwealth Central Credit Union Account #118881. You can do this by contacting any credit union.


2) Via your PayPal account. Go to www.PayPal.com Send funds to: StowDonations@gmail.com


3) Visit the blog set up for him Support4Stow


4) Get on twitter and spread the word far and wide.


If you can donate money, please do.  If not, and I understand, could you spend a few minutes mentioning this fundraiser on facebook, twitter, myspace, the wall of your local starbucks, shout it at passing cars, spread the word as best you can.


The more eyes we can get on this effort, the better chance of someone seeing it who can donate.


ALSO: Visit the page his employer, AMR, set up


 


Thanks!

Wednesday, April 13

Real Firefighter Olympics

From our friends at Gasda Software, creators of the BlackBerry Shift Calendar, a link to what real firefighter olympics look like.  Last ones I went to had darts and bowling.  Thanks D!

 

Tuesday, April 12

Which liability?

[caption id="" align="alignleft" width="240" caption="Detroit by Patricia Drury on flickr"]Detroit by Patricia Drury on flickr[/caption]I've discussed this here many, many, many times before.


 


When you trade actual liability for perceived liability, it kills people and gets bad press in the process.


 


The perceived liability that a patient will sue you for not taking them in for a clearly non-medical complaint pales in comparrison with the ACTUAL liability of having too few ambulances to handle actual emergencies.


 


Whether your solution to this mess is privitization (Yeah, try to turn a profit there.  Or here for that matter) or not, the solution is clear.  It is time EMS stands up and says "NO."


I am a trained medical professional armed with state of the art equipment to assess your chief complaint and I have found that you do not need an ambulance so I will arrange alternative transport to the physician.


No more transport them all and let the MDs sort it out.  It never worked, it will never work.


 


Detroit EMS, as with most other systems, including my own, have chosen to hide behind a false definition of liability, instead rolling the dice and hoping nothing will happen.


And we all know what happens when you work in EMS and hope nothing will happen.


A senior staffer will likely step down, replaced by another senior staffer who will enact the same policies and wonder if something new will happen.


See also: Insanity

Sunday, April 10

Sunday Fun - New Triage Tag

We have all come to be familiar with the black, red, yellow and green triage tags and train repeatedly on thier application.  Whether it's a neumonic a 5th grader can follow or based on common sense assessment, we know the green are slightly injured and the black tagged folks are dead.  The red and yellow cover everything else from a respiratory rate of 31 to myself, with a natural cap refill of 3-5 seconds.


We are trained to assess, tag and go to the next person.


The system works great on table top scenarios, in drills and even in the field at mass casualty incidents, but I was inspired recently to introduce a new color/tag/classification to the triage kit.


I know, exactly what we need, right? Another confusing category.


 


Well, this one makes it even easier, believe it or not.


White.


[caption id="" align="alignleft" width="193" caption="White Flag by erix!"]White Flag by erix![/caption]I am officially adding WHITE to the triage category here at HMHQ.


When triaging you will no doubt come across persons with no injury, illness or complaint, but see the opportunity to become part of what they believe will be a chance to make a few bucks.  This is not uncommon in my area during bus incidents.  A bus will have a minor collision or hard stop and call for help.  Before help arrives, people will climb on the bus and create injuries inconsistent with the collision or direction of hard stop.


These people will fall into the NEW classification of WHITE or "I surrender."


When in a triage situation, if I encounter someone who is uninjured and ambulatory, they are not "walking wounded" but simply "walking."  Last I checked we can do very little for the "walking" other than sitting them down, tagging them green and wasting what few resources we have on them.


Same goes for persons displaced after a fire in their building or adjoining buildings.  They should be triaged WHITE and told to wait nearby for information from the Red Cross or other agency who can help them.  If there is no injury, a green tag seems wasteful, does it not?


Have you ever encountered an MCI with a crowd?  How do you know who is hurt and who is not?  By asking?  Great assessment skills there, Sparky.  Don't let your mind get lost in the sea of "Oh my God there's 10 of them!" and remember that you are doing triage based on your agency's instructions.  Chances are you're using the START Triage system, which assumes by the time you arrive and assess that life threats will be already changing mentation, respirations and perfusion.  Keep in mind that an ambulatory person missing an arm, breathing 22 times a minute with good cap refill on the remaining arm is a green under this system.


But let's get back to the lady wandering the triage area asking who to talk to about suing the building owner/bus company, or who states they were hit by debris but show no signs?  Are they GREEN or are they something less?


Currently the system does not let you make that determination.  After all, what do you know anyway.  Just tag them and deal with it later.  And by later, I mean let treatment sort it out, right?  While it does take a short amount of time to properly tag a person with name, age, allergies, medications, pulse, respiration and mentation status, we could be helping the next person who actually needs us.


Getting to them later is not a liability, spending time confirming they are uninjured is the liability.


So why does the system not account for the liability of the "walking?"


 


Because until now there was no WHITE category.


To be tagged WHITE in an MCI a person (they are not injured so are not a patient) must:


1) Be ambulatory


2) Have no sign or symptom of illness or injury


 


There, wasn't that easy?  I just saved you 8 backboards and 3 ambulances at your MCI.

Thursday, April 7

$92,000 - Stow fund grows

Bryan Stow's friends, co-workers and even total strangers gathered at the Santa Clara American Medical Response Depot on Wednesday for an all out BBQ to raise funds for Bryan's medical bills and cover costs while the father of 2 recovers from an assault on March 30th.


 


FRNtv was on scene to record some videos for Bryan from his family and co-workers, somethign they can play for him to listen to, but we were also there to lend our support.


T-shirts, hats, bracelets and other fund raising items were sold, but I was blown away by the silent auction items and the current bids as of 2 pm (with 6 hours to go).  The SF Giants stepped up big with items from the players, as did local San Jose Earthquakes Soccer and Sharks Hockey.


Local artisans gave what they could in the way of products and services and I even saw a 3"x3" tattoo with a bid of over $300.


 


The food was amazing, there were treats for the kids and there were so many different fire, EMS and law enforcement agencies represented, collecting all their names would have given me a migraine.


A pizza fund raiser the day before was sponsored by Pizza My Heart and rasied $20,000 for the Stow Fund.  Here's a little bit of video Thaddeus put together today as well as a reminder of how you can donate.

Family Disaster Plan - Time to revisit it

In the wake of the Bryan Stow assault, I am reminded to update and review my family disaster plan.


We have an elaborate plan, but it all started with creating living wills in case something were to happen to one of us, just like it happened to Bryan.


This tab used to be up in the page list and perhaps it is time to bring it back:


 


Disaster Plan


 


Talk to your family today about what happens when the unthinkable happens.


In addition, thank you to everyone who came by Santa Clara county AMR yesterday for Bryan's fundraiser, word is we gathered over $100,000 for Bryan and his family.  Thank you.


 

Monday, April 4

How many ounces is the large? - Beer Video

I'm not sure if i should laugh or cry.


 


[youtube]http://www.youtube.com/watch?v=1xSDI9Gg63I[/youtube]


 


Questions is: Does the proprieter of the beverage stand KNOWINGLY mislead the patrons, and if so, does he instruct the vendors not to mention the small is the same as a large?


 


We may never know, instead of changing the cups, the prices are now the same.  $7.25 for about 20 cents worth of beer.


 

Saturday, April 2

The Pajama Brigade makes an Impression

I have spoken before about my distaste for what passes as uniforms in many a medical establishment.

Scrubs.

Scrubs are pajamas.  Initially a simple garment to be worn and left in the operating arena, the scrubs are now available in many a color and pattern to be worn by nurses, billing agents, medical assistants, doctors and anyone else in any way associated with physicians.

The fact that most people have no idea the difference between the girl who takes their copays and the nurse that evaluates them, most people assume they are all "nurses."

On a recent trip to the local Brewery/Restaurant I frequent the Pajama Bridage was in full force.  In a corner of the bar area, which is open to the maybe 30 table dining area a dozen or so pajama clad folks were loudly discussing their favorite clients and patients from that week.

I mention loudly because a few of them felt the need to yell patient information over the sound of their laughing friends.

Alcohol was involved, sure, but so was poor judgment.

After watching most of those around me turn to them and scour, I decided to give them a heads up they were not only being rude, but if I knew where they worked, were clearly violating both the letter and intent of HIPAA's current form.

"Hey guys, I hate to interrupt, but you're not only very loud, but I work in the healthcare industry and some of the things you're saying could be considered violation of patient privacy."

"Mind your own business," was he only reply I got from the young lady closest to the man I spoke to, who chose not to even look to me when I spoke.

Returning to my seat, they started up again, laughing, banging the table in hysterics and each trying to outdo the last with tales of "lazy," "ugly," "deformed," "stupid" people they had seen this week.

What upset me the most was that had they said the same things online they would all have been fired, likely because we would then know their names and where they worked.

Then my mind shifted to the uproar and headlines if a group of paramedics in uniform were having the same discussion (sans drinks).  Heads would role, careers would come to an end.

But for some reason the pajamas bring with them an aire of respectability, an assumption of a hard working floor nurse who deserves to unwind after a long week.  I know from what they were discussing they are likely not even nurses, but technicians and desk clerks, and how would the average person ever know that?

Nurses need to stand up and differentiate themselves from the pajama clad masses who continue to distort the public's image of their profession.  Ditch the pajamas and accept something more like what I saw in England, or something from your past, something with some class to it.  Something that when you walk in a room I'm not wondering if you just rolled out of bed, but see you as someone who respects their line of work enough to dress the part.

 

The kids at bar making you look bad look just like you and feel comfortable enough in their pajamas to hit the bar after a long day of supporting your hard work.