Tuesday, October 29

Halloween and Christmas rolled into one

In all the EMS debates over BLS vs ALS, evidence based vs anecdotal, public vs private is the real reason we do what we do.  I like to say that we make bad days better.  More often than not we ride the bench.  Sometimes we get the grand slam in the bottom of the ninth to win the game.


I got a facebook message from a reader who was looking for a spark to get out of a rut and gave the best advice I could.  My response included examples where we find joy in this work: The smile from the woman who's hand we hold when nothing is wrong, the man who half smiles at his wife when he sees her as we unload him at hospital having a massive stroke.  There are so many small victories in this world sometimes we miss them.  If you are looking for medals or public recognition in EMS I have bad news for you: It will be a long, lonely wait.


 


But sometimes that wait pays off.  I had no idea that the best motivation to be a good Paramedic or EMT would come in my email inbox early this morning.


8 months ago today a man died.  Dead.  Asystole.


Then some of my co-workers showed up.


This morning we got an email with a photo.  The photo showed our patient dressed up for Halloween with his young daughter.  He was Obi Wan Kenobi and she was Princess Leia.


His smile made me smile.


Her smile made me forget all the bullshit.


Although I keep a running tally of cardiac arrest saves on a white board in my office, this is my first photo of a smiling child.  And hopefully not the last.

Friday, October 18

Righty tighty...

Being back in the field is a wonderful thing.  The smell of week old urine on a regular, the thrill of getting the line on the recus patient and even just sitting in the buggy at a street corner catching up on QA.  But I was not prepared for what happened today.

THE EMREGENCY

A local clinic has called in a code 3 transfer for an asthmatic patient.

THE ACTION

Well, this sounds like a good one.  With at least one MD and a scattering of RNs in the office for them to call 911 before 5PM means it must be something serious.

Stop giggling.

I add myself to the run and head over the few blocks to the well known clinic as the engine company pulls up.  We head inside and are led, rather swiftly, to an exam room where our patient is working on sucking a non-rebreather bag back through the tiny hole in the mask.

"Hi there, what seems to be the trouble today?" I ask seeing a look of panic on the patient's face.

"His sats are dropping and the albuterol isn't helping!" a pajama clad medical office worker is telling me as she's fumbling with the tiny O2 sat monitor on his finger.

"Well, let's switch this to one of ours to start" the Engine Medic and EMT have prepared a mask on 15 liters with a well filled bag and the patient drinks in the fresh air, the look of panic quickly receding and relief taking it's place.

"Thanks guys, the albutrol must have finally kicked in" the pajamas tell the room, hoping it will cover up the look on her face that she is still completely dumbfounded as to what happened.

"Here's your trouble" the Engine officer says as if noticing an oddly shaped cloud, "Yer tank ain't on." And as soon as I can turn around to see the EMT still holding the clinic's mask the officer turns the key on the top of the clinic's O2 tank and air begins to flow.

"Beginner's mistake I guess" he says as he shuts it off and looks to me barely holding my professional pose. "Unless you need us Cap, we'll be on our way."

I cleared the Engine and comforted the patient who's "low sat" of 94% had risen to a comfortable 96%.  The ambulance arrived to take him in to Saint Farthest, per his request, and I relayed the situation.  The pajama clad person had left just after the engine and now came in with what was clearly an experienced RN.

"I think the tank is faulty." She told the older RN.

"I don't think it's the tank, Dear.  Thanks, guys." And down the hall they went.

"What was all that about?" the ambulance EMT asked as we wheeled the now calm patient to the elevator.

"She didn't know how those tanks worked.  Can you believe that?" the patient chimed in with not a hint of distress.

And to their credit the crew kept a straight face as the doors closed.

Saturday, October 12

Hate Firefighters that complain about EMS? You might be one. I was.

It is no surprise that anyone working in the Fire Department who hates EMS is in for a rough career.


I have met many a "Basic for Life" who groans everytime the bells ring and it is not a fire.  Some even groan at building alarms.


I was talking with a colleague recently and we stumbled into the problem most in EMS struggle with and one I built this platform on:  BS calls.


You might be thinking "Justin, calling them BS calls isn't respectful.  It's that kind of attitude that encourages less than Professional actions by our low information voter EMS types."


But they are BS calls.  The scraped knees, the MVCs without injury some passerby called in, the headaches after slurpees and stomach aches after a seafood dinner, all BS calls.


And if you agree then you still have a lot to learn about modern, and I'll argue future, EMS.


If you argue that you only exist for emergencies and the other calls waste your time, your argument is no different than the firefighter claiming they are there to fight fire, not wipe asses.


So let's rename BS calls as Basic Service Calls.  Not EMT Basic, but Basic care.


You exist to assess.  So many in EMS list their abilities to treat as their claim to fame when we have all known for a long time that treatments are useless without a complete assessment.  That headache, stomach ache, every call you go on deserves a complete assessment to determine possible solutions to you patient's chief complaint.  If your main reason for assessing is simply whether this will be a transport or not, perhaps we should get you an application at Dairy Queen.  I can say that, I used to work there.  If all you d is check your boxes on the ePCR and exclude the patient from your box of tricks are you even addressing their concerns?


Every single call you are sent to is someone who didn't know what else to do.  What an amazing opportunity to help them.  Not with a 12-lead most times, or albuterol even, but listening to their concerns and reacting to them.


If the guy on 3rd street keeps calling every time he runs out of meds, can we possibly help him figure out why instead of getting upset he called again?  In case you haven't noticed, getting mad and yelling at him only makes him call and complain in between calls for 911 to refill his meds.


Getting upset isn't working.  So instead, get involved.  It will take just as long to complete a transport or refusal helping him or ignoring him so why not make the time you have with him useful?


You don't need Advanced Practice, Community Paramedicine or (I can' believe I'm about to type this) Integrated Mobile Healthcare (ewww) to make a positive impact while still acting within your scope of practice.  There is no law that keeps you from being a patient advocate.  Since he called you for medical care you are now able to access his medical record (as much as he gives permission for) to determine what may be the trouble.  Call his Doctor's office and mention to the clerk who answers that you are on a 911 call and need to speak to his Doctor.  Dude will be on the phone in a heartbeat.  If the van service from the managed care service is always late or keeps skipping the house, make a call.  If the home care nurse isn't doing what they are supposed to be doing, ask for their agency's contact information and follow up with your concerns.


All of this can be done in the same time frame as your frustrated conversation with your regular that will end the same way it always does unless you change your perception.


He IS the reason you are here.


Like the Fire Service before us we are doing a great job at preventing major medical issues and because everyone seems so intent on getting to any scene as fast as possible, we see many conditions far earlier than before, meaning they're not as dire as our 20 year veteran colleagues remember.


We are the safety net these people need when their insurance company fails them.  We are the number they call when Medicare can't cover everything.  We can make a difference if we try and we don't even need to try very hard.


These calls will frustrate you.  They frustrated me so much I wrote about them.  As I did I realized I was getting frustrated for no reason at all and that I alone had the power to help these people.  That's where EMS 2.0 became a reality for me.  That's when Chronicles jumped off and my perceptions changed forever.  Had I kept stewing in my frustrations there is no telling where my sanity would be.


If you disagree with me and believe the first word in EMS is more important than the last word in EMS give up ever becoming a Professional.  You'll burn out in a few years and I hope you don't hurt anyone between now and then.


It's time to take the extra step so many think is not their job, not their responsibility or not in their power:  Help people.


 

Tuesday, October 8

Being a Fireman, as imagined by children

I'm going to need 4 minutes of your time for this training video.


 


I think I worked with this guy down in District 4 20 years ago.

Thursday, October 3

Kelly Grayson belly flops with cliches, proves he's a Noob

"Ambulance Driver" Kelly Grayson proved his ignurences (aside from keeping us down by repeatedly refusing to stop calling himself an ambulance driver) in a recent column from EMS1.com where he "debunked" some EMS cliches.

This article proved to me that this Kelly person is not fit to write for any magazine or website.  Anyone who's been in EMS as long as me and worked as many calls as me HAS to see just how wrong Kelly is.  I've taken his 10 cliches and written my responses:

10. “Paramedics save lives, EMTs save paramedics.” This is the #1 truth in EMS.  I can't tell you how many times I get on scene and start an ALS assessment on a patient and an EMT swoops in and places the patient on 15 liters of high flow.  I forget all the time that O2 should be applied for anything.  My EMTs also remind me to recheck blood pressures and check my splinting.  EMTs DO save Paramedics Kelly, if you give them a chance!

9. “Here to save your ass, not kiss it.” We are being misused at an alarming rate.  I had a call just yesterday where a woman wanted us to refill her prescription.  "You call, we haul."  I wish they'd stop calling us and wasting our time.  What does she expect me to do? Explain the basics on healthcare?  I don't have time for that, we're a 911 service.

8. “We cheat death.”  We do, daily!  I have a T-shirt with the Grim Reaper being slapped in the face by a bad ass medic with sunglasses and everything.  You are so narrow minded you can't see how we bring the dead back everyday.  Epi works Kelly!

7. “Seconds count.” Try holding your breath for 3 minutes and see what happens.  I can't stand it when some washed up middle manager tries to tell me that we drove too fast or opposed traffic to the IFT.  We are en emergency service and I took a 3 hour driving course.

6. “I don’t have X-ray eyes.” If they think it's broken, what do they want us to do Kelly? Huh?  Guess what happened?  If I did have an X-ray machine would that change my treatment? I didn't think so.

5. “They should have gone to medical school if they wanted to be a doctor.” I spent 6 months in EMT school and another 11 in Paramedic School.  If there was something else I needed to know to treat from my Protocols, I'd know it.  Protocols are laws written by Doctors.  If I step outside those protocols, no matter the outcome, I will get stepped on and fired, no questions asked.  If they wanted me to learn more, why are the renewal credits where they are?  You can't answer that one can you?  If 24 hours is enough to keep doing what I'm doing, I'll keep taking the same 5 classes and cheating death on a daily basis.

4. “Zero to hero.” Classroom and book learning is a start, but you need true street experience to be a real EMT or Paramedic.  Only in the truck, getting puked on and standing in blood everyday can you truly realize and understand what it is we go through.  When you see death first hand it changes you.  It hardens you.  That's why I can't stand all the BS PC talk on facebook.  If you can't take a joke, get out of EMS!  What we see every day would leave regular people in a puddle of piss, so yeah, the street is the only place to learn what it is we do.  You could take a doctor and put them out here and they'd shit their britches.

3. “If it saves one life, it’s worth it.” What if it was your Mom?  What then?  The cost of 1 human life can't be calculated, I looked it up on wikidepia.

2. “I save lives for a living.” Damn right!  I suit up against Death, kick the Grim Reaper in the ass and take names later.  That's what we're there for Kelly, not all this BS moving people around because they are entitled whiny losers.  I don't remember the whiny brat portion of Paramedic School.

1. “Treat the patient, not the monitor.” All your fancy ALS machines don't tell you squat if you're not looking at the patient!  Get them on O2 and watch them change in front of your eyes.  Sat monitors are useless.  Just give them some O2 already!  EKG?  Not so fast!  Basic before Advanced!  Take a pulse, count respirations, give O2, check a blood sugar, get a BP.  Then and ONLY then should you be applying the monitor.

 

Kelly, your cliche list proves to me one of 3 things:  Either you are a Noob in EMS, have never done any time on the streets, or you're burnt out.  Either way I'm not going to listen to you, whoever you are.  I just saw an update on a facebook group I follow that belittles patients, makes off color comments about death and shares other updates that I agree with.  Keep your fancy learning to yourself, NOOB!

 

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