Thursday, May 25

Always, In Service - EMS Week 2017

EMS Week seems to be plugging right along, as usual, with a few nice things here and there.  New York Buildings lit up in Orange, Blue and White for example, or a day when ambulances are on display infront of City Hall like in San Francisco.

Coast to coast EMS Week reminds us that we remain an afterthought.

National EMS Organizations are only now catching up with 5-6 year old concepts while we on the rigs struggle to keep going day to day.  Happy with table scraps we seem content to uphold the status quo while listening to the same presenters at the same conferences speak on the same topics.  I'm not immune, but I do try to change things up.

This year's EMS Week slogan is "Always in Service" and I hated it just as much as the last ones.  It brings a connotation that we are always there to answer the call...Always ready to jump into danger.

The modern state of EMS is anything but.

A better, more honest slogan would have been EMS Week 2017: Any unit available to take a code 2 fall?

I decided to add a comma to this year's slogan, let me explain why.

Friend of the blog Scott Kier penned an article earlier this week that had me sitting in my chair for a good 15 minutes trying to figure out how he so clearly stated what I have been trying to say for years.  Read it HERE and come back.

You are not this job.

You are not this Calling.

You are a person with dreams and desires and hopes and fears and whatever else you cram into your waking hours.  If EMS falls in there somewhere...cool.  If you're here for the guts and the glory I still have the same bad news for you: There is divorce, depression and substance abuse in your future.

If you're here because one time, early on in all this thing we call EMS you made someone smile and that ignited a fire inside your soul...cool.

We are not always in service.  When heading home and I see a car on it's side in the trees, people pulling over and I have no gear...I keep driving.  What am I going to do without my gear?  Get hurt?  Maybe make a difference?  I've pulled up to too many scenes when on duty to see how folks like that can cause more harm than good.  Sure I stop sometimes but not always.

MC and I discussed this topic on a recent Crossover Podcast after he pulled over simply because no one else was.

 

I want to add a comma to this year's EMS Week slogan because I see it being embodied by so many for all the wrong reasons.  I want you to have a life outside EMS, just like Scott encourages and I want to take his theme and expand on it.

I want you to be a different person when you are at home.  I want you to be that big Baseball fan, gourmet chef or scrap booking king.  I need you as a little league coach, PTA board member and fund raiser.

When we hit AOR on the rig, I need you Always, in Service.

In Service to your partner, crew and company.

In Service to the community we protect.

In Service to make someone's bad day better, whether it be getting your ass handed to you with 15 runs in 12 hours or 5 take homes on the BLS car.

In Service to those who pick up the phone because they don't know who else to call.

In Service to those who need us just as much as those who don't, whether they know it or not.

 

Always.  Every call for service.

 

When we log off and get back to the yard, decompress and go back to being you.

Volunteer?  I need the same.  From the time you pager drops that tone to the time you're back home, back at work and back with the family I need 100%. Always.

 

It is easy to throw a slogan on a bumper sticker or a T-shirt but not until we start to live our lives without EMS will we realize just how important quality service is for our communities.

 

Always, in Service,

 

-HM

Friday, May 5

Lost Cause gets cocky

I do love a good medical call.  Don't get me wrong, I don't wish illness upon people, I just get really excited when I encounter someone suffering from something I can help with.  I don't mind the minor injuries and sickness that comes with not being prepared for your day but there is something about a person with an as yet unknown illness presenting in unique ways we must detect that makes me glad I paid attention in Paramedic School.

To be able to assess, combine a detailed history and list of meds, obtain an ECG and a BP then apply my diagnosis with interventions and reassessments is just...poetry.

But you all know where this is going if Lost Cause is involved.

 

Male, late 60s, over dressed for the weather, over weight for anything, pale cool and diaphoretic.  Dude read the textbook.

I'm onscene early getting an irregular pulse rate, maybe 6:1 early.  Chest Pain is a 7, down from a 10 after his nitro tab.

Ah ha.

I begin taking a BP as I prep the nitro spray.  as soon as I hear a "lub" at 160 I give him a spray.

"What do you need?" I hear from over my shoulder.

Lost Cause.  The Paramedic unsure of the use of 12 lead ECG and stead fast in their belief that Paramedics can not diagnose.  If Tor Eckman was on this rig they'd be a perfect matched set.

"Symptomatic chest pain with history, first nitro brought pain from 10-7, hypertensive, let's get him on the monitor."

"Do you want to goto the hospital today Sir?"  Oh hell no.  You did not just ask that of the clearly emergent cardiac patient infront of you.  Did you?

"No, I think I'll be OK" the patient says through gritted teeth giving a Levine's sign visible from the space station.

"ECG please. Prep for a 12 lead and let's get ready to move."

Lead II tells me most of what we need to know but the lab will want to see what we found.

12 Lead, after coaching Lost Cause on lead placement, shows infarct in Lead I, II, V2, V3, V4 and V5, ischemia in V1 and V6 and Lead I is somewhere in between the 2.

All criteria are met, everything indicates PCI facility without delay and nitro until I'm out. (you know what I mean)

Lost Cause looks up from the monitor only after the interpretation has printed, "Well, Sir, we can't," slowly he turns his head towards me and lets out a small smile, "diagnose you here.  We're not Doctors.  Do you want to go to the hospital?"

I stepped in.

"Sir, our assessment has led us to find your heart is under a massive amount of strain and needs immediate relief.  We are going to treat your symptoms based on our diagnosis and get you to definitive care without delay."

He agreed, Lost Cause let out a sigh.  The same sigh he had later during a retraining session I'm told.

 

The next day, on an overtime, I ducked into St Closest and asked in on our patient.  90% occlusions in 2 arteries and he's been stented.  The 2 arteries we saw on the 12 lead which guided our diagnosis, treatment and reassessment.