Archive for February, 2010

28
Feb
10

I Am Medic, Hear Me Roar

By Jeramedic 8 Comments
Categories: Rants
Tags: , , , , , , , ,

I am Medic, and for that I am quite an interesting creature. I come from a military ancestry. My family was in all of the great wars, and the not so great as well.

In the the mid 1900′s I slowly grew and fought for a place in the world. In the 1970′s, a landmark television show told my stories every week And helped to introduce my mission to the public.

During the 1990′s and early 2000′s, I educated my self  and battled legislation and health care reform.

Now today I am once again in the media (a bit more then in the 70′s) and I am preparing to move forward in my life.

But as glamorous as my life may sound, there is another side. The side that is lost and confused. The side that is poor. The side that is disrespected and misunderstood  by the public and my medical piers. The side that is expected to work faster, better, longer, 24/7 no matter what.

I am the bastard child of health care and the foster child of the fire service. Neither of my parents know what to do with me, and they get mad at me when I ask them for help.

I care a lot about my self and for the people in this world, but I find it harder and harder to do even the minimum anymore. Some times I feel like I should run away and leave the world and my so called “friends” behind. To leave them alone to handle their own emergencies them selves. maybe once I’m gone they’ll realize how important I was, and how wrong the were to treat me that way.

The sad part is that no matter how bad it gets, I don’t think I could ever leave. I’ve been here too long. The need is so big and I care too much to go now. I would work for free and drag myself on bloody stumps to just help one more unfortunate soul.

I am lost. I am confused. And I really need to sleep. What can I do?

Well let me think…..

I am extremely resourceful, and can do more with less. Hell what can I say, I’m used to it.

I can do five things with two hands and never break a sweat.

I have never met you, but in 10 minutes will know everything about you.

I can diagnose from across the room.

I have never been to medical school, but have gone toe to toe with many physicians .

I know my community intimately and it’s citizens better then any mayor has.

I will care for you when you are ill. I will hold your hand when you are afraid.

I will witness horror and tragedy without flinching, and find the good in any situation.

I am honest, caring, trustworthy, smart, professional, resilient, and unrelentingly passionate about  helping others.

I am Here, and the time for change is now. And I’m not going down without a fight.

I Am Medic, Hear Me Roar!

24
Feb
10

ALS Kills People

By Jeramedic 37 Comments
Categories: Rants
Tags: , , , , , , , , , , ,

While I was in Paramedic school, my instructors would say things like “you’re not a real medic until you’ve killed someone” and “soon you will all have your P-cards and a license to kill”

Studies show that ALS interventions give little to no benefit to trauma patients, and in some cases cause harm. We also still have no hard evidence that ACLS drugs are effective during cardiac arrest.

Systems across the country are downsizing their scope of practice, and losing medications and procedures because mistakes are being made in the field. And some medical directors are feeling like ALS is more of a risk then a gain.

The logical conclusion? ALS Kills People. Well, let me be a bit more specific. ALS kills people when it is used inappropriately and or incorrectly.

Don’t get me wrong, I am a firm believer in the benefit and need for ALS care in the field. But it must be done right. Otherwise you run a high risk of  killing someone.  I know you have heard it before, but its BLS before ALS. And it takes a good EMT to be a good paramedic. And I of course agree, I would also add that a well educated Paramedic with BLS equipment will give better care then an average Paramedic with ALS equipment.

So where am I going with all this? The answer is education, more emphasis on high quality BLS care, followed by appropriate ALS interventions. ALS care,well any level of care for that mater is a two way street of skill and knowledge. With out a thorough education base to start from, is it any wonder why intubation success rates are low and pneumonia patients are receiving Lasix. Not when you consider the fact that some clinical sites don’t allow students to intubate, or that some schools teach airway in a 8hr block and then move on. Another reason ALS is often harmful and seen as a liability, is because many of our new (under educated and under trained) providers go into the field and are so excited to play with their new toys they forget BLS and are unnecessarily aggressive with ALS. Again, this all comes back to more education.

Up until recently, the general consensus has been to remove procedures that are considered “an opportunity for error or that are infrequently used”,  rather then provide more training and education to prevent errors and keep less utilized skills current. Why Is it so taboo  to want more for our patients and our profession? Should a police department get rid of it’s SWAT team because it’s been 15 years since a hostage situation? Should  fire engines respond without lights and sirens because it’s potentially dangerous to other drivers? So why should EMS stop using medications that are harmful when Improperly Used? Or remove procedures that are only used on 5% of the patients.

This is an opportunity to adopt some things from our colleagues in Fire and Law Enforcement. Because as different as our roles are, they are also similar.  I am a big supporter of frequent In service trainings and drills. The Fire service often trains and drills for operations that may have  been done in the field only a few times in the history of the department, in addition to training on daily operations.  Police Officers are frequently at the firing range, even though they may go their entire career without drawing their gun in the field.

EMS is very much the same. we are educated, trained and equipped for the worst. Even though most calls meet BLS criteria, or less. But for that 10% who are legitimately critical ,we still need ALS. So how do prepare for the worst? By completing 48hrs of continuing education every two years…… Really? Kinda embarrassing when you think about.   Go look in the back of your ambulance and consider how many things we carry, and how many are actually used on a daily basis.  Then consider how many things you remember how to use (Properly)

We as individual providers and as a profession can not just wait for the National Registry or our local agencies to require more from us, because they won’t. We need to be responsible and proactive for our industry and require more from them, and from our selves.

As individuals we can educate our selves and practice skills on our own or in small groups. As a profession we can raise the bar for all of us  by increasing the minimum standards for employment. Individual schools can increase the required hours (or years) of education, and begin asking for more prerequisites. The industry standards will not change for us, we must change the industry. And it starts today with you.

If you are interested more on the importance of good BLS care, Steve Whitehead has a great post on the subject. Also   Rescue Monkey brings a different perspective, and adds a good dove tail to the issue.

19
Feb
10

The Chronicles of EMS Weekend

By Jeramedic 6 Comments
Categories: Events
Tags: , , , , , , , , ,

Last weekend was the long awaited and very much anticipated premiere of the Chronicles of EMS.  If you don’t know about the Chronicles of EMS or “CoEMS” as it’s come to be, then you best be sending some clickage over HERE. This is not going to be a review of the of the weekend or of CoEMS, there are other bloggers, websites, and magazines for that. Rather this will be my own personal account of the weekend and the event.  Who I met, where I went, and what it all means to me.

I will say this however. What Mark Glencorse, Justin Schorr and Ted Setla have created with CoEMS and where it will take our profession is amazing. And I could not think of a better or more needed time for this to be happening. I am very proud of them and everyone involved with the project. I am also very happy and privileged to be contributing to the “EMS 2.0″ movement.

So lets begin.

Thursday the the 11th

I arrived in San Francisco around 6pm and checked into the eclectically furnished and rather posh Frank Hotel. This was a great location that Justin and Ted chose for the event. Last year I spent a lot of time in San Francisco, and I was happy to be back.  After I was settled in and all of the phone calls back to base had been made, it was time for dinner. After a series of emails, tweets, skypes and phone calls. I realized that I was the only one there, and thus would be dinning alone. I ordered take away from a restaurant down the block from the hotel, and wile walking back remembered what it was like to be in a proper city again.

After dinner and a few more phone calls, I skyped with Ted Setla for about an hour. We talked about his projects, past, present and future. We also  discussed  plans for the premier the next night and so on. At around 12:30am  I saw a tweet by Chris Kaiser (Paramedic/firefighter and author of  Life Under The Lights) saying that he had landed in San Francisco. He checked into the hotel and we made plans to go out for some late night  nosh and conversation. we met in front of the hotel, and it was the first of many meetings and friendships of the weekend. He was accompanied by his lovely wife Gina, a Paramedic student and firefighter herself. We went to a late night diner around the corner and were very quickly talking to each other as if we had been friends for years.  It’s easy to chat when you share a life of EMS, but Chris and Gina were different. And as I was soon to find out, so was everyone I would meet this weekend.

Friday the 12th, and premier day.

Here it was, nearly a year in the making. And it started with me heading out to the airport to pick up the charming “Ms Paramedic“  and host of the GenMed Show Natalie Quebodeaux. She and I think and feel very much the same way on a lot of subjects. And we are both very passionate about our careers, and being part of the change in medicine.

On the way back to the hotel, I tried to give some what of a tour through the fog and getting a bit lost. Later we met up with the Kaisers and Greg Friese (of Every Day EMS Tips and host of the EMS Educast) for lunch. Once again conversation was easy, and managed to fine it’s way back to EMS or education.

In the Lobby of the hotel, Natalie and I ran into Ted Setla and Sam Bradley. Sam  (and I mean this in a good way) has been a Paramedic for longer then I have been alive. Nearly two decades of that career were spent in my home town, Running calls on the same streets as me. In addition to her many, many other accomplishments, including to help author my EMT text book. She is also someone who inspired my to start writing. (Thank you Sam)

Show Time

6pm and dressed to impress, I met Ms Paramedic in the lobby and together we entered the “room F” for the pre party and meet and greet before the premier. We were met at the door by Mark and Justin, Ted was in the corner surrounded be laptops and cameras. ( I think he’s more comfortable that way )  I Then met Chris Blair ( a medic with SFFD) and his fiance Amy. “Chris I’m sorry we did not speak longer”

Food, Drink and chatter filed the room as bloggers met podcasters. Medics met Doctors. And very quickly we all realized that the Hollywood illusion of celebrity bloggers, podcasters, authors and speaker was just that, an illusion. We are all one and the same, professionals  on a mission  you might say.  In the very large world of EMS, there is only a small percent active in the movement of EMS 2.0. And a large amount of that small percent was in that room.  The energy  was exciting and palpable.  I was Home.

The Chronicle of EMS delivered as promised. A raw, unbridled look into this countries Healthcare crisis and the emergency services  state of emergency.

After the show there were congratulatory toasts, interviews and more schmoozing to be had. I had a great time meeting and speaking with so many wonderful and enthusiastic  people . I spoke with A.J Heightmen the editor and chief of JEMS Magazine, and also Kris Kaull of EMS1.com.  And yes I’ll be honest, I was a little starstruck

Now it was time for dinner. And I was graciously invited to dine at Farallon with Chis Montera (host of the EMS Garage) and his wife Amy, Dr Wesley and his charming wife Karen, Chris and Gina Kaiser, Greg Friese, Sam Bradley and her friend Dr James Brasiel (a former Paramedic him self) and of course Natalie. It was a delightful experience. The food and drinks were great. As some of you my know, I’m a vegetarian. And despite that fact that Farallon is a sea food restaurant, The staff was very accommodating. “Thank you Mr waiter, I’m sorry I don’t remember your name.” We talked about family, NASCAR, Superbowl commercials, education, and of course medicine. I even got into a friendly debate with Dr wesley about scope of practice and rural vs urban EMS. (one of many highlights of the evening)

After dinner it was back to the hotel bar for drinks and more great conversation with Natalie, Sam, The Kaisers and Dr Brasiel.  (How one wishes the night would never end)

Saturday the 12th

I left San Francisco early to drive over 300 miles to attend the wedding of a very dear friend and ex partner/crew mate. We danced, we laughed, and we hugged.  Later myself and another friend and crew mate, Had the DJ play some songs from our days on the ambulance together as sort of a send off to the groom. He loved it, and in all the years I’ve known him I don’t think I had ever seen him as happy as he was that night.  The wedding was beautiful, I am so happy for them and I wish them the best.

During the wedding I got word of a lunch back in San Francisco. Rumor had it that some of my new friends were a bit disappointed I would not be attending. I was still on a bit of high from the past 36 hours and thought, why not? when would I have this opportunity again? After all Mark was flying back to England right after lunch, and he was someone I did not spend much time with and wish I had.

Sunday the 13th

So, back in the car and another 300 and some odd miles later I was back in San Francisco.  I had Lunch with Justin Schorr and met his “Happy” family of wife Kim, and his two daughters Eliza and Morgan. The Kaisers were also there as well as Natalie. Unfortunately, Mark had to leave for the airport sooner then expected (until next time my friend) But even so, it was still a great afternoon and a one of a kind weekend.

(I am still recovering)

***Want to new more about The Chronicles and EMS 2.0? Listen to my interview on the GenMed Show.***

08
Feb
10

Diseases of the Nation

By Jeramedic 3 Comments
Categories: Rants
Tags: , , , , , , ,

What is the desease of the nation?

Is it Heart disease?

Is it Diabetes?

Really I think if any disease can get so common somewhere that it can become a part of the culture, then we have a problem. The disease I’m thinking about at this moment is a little different. The problem with this disease is that it can’t be prevented with diet and exercise, or prescribed an inhaler. The problem with this diseases, is that it’s us. And we can’t just start killing each other off with some social antibiotics to fix it, because killing each other is the problem.

I’m talking about violence.  And it’s not so  much a disease of the nation as it is a diseases of humanity. I don’t know why this is on my mind today. But it is related to a conversation I had with an old friend and crew mate last week. We were sharing memories and stories as EMS people tend to do. He was telling me about how things had changed at the station since I had left.

There was the usual news. New crew, different vibe, same patients…well almost.  We were talking about some of our frequent customers, some old favorites, and some not so favorite. He was telling me that some of our frequents had died, sadly for some it was expected. The ones that were elderly and chronically ill, I knew sooner or later I’d get the bad news (or be the one giving it)

Whats not so expected is when the 23y/o girl with asthma dies, the one who lives on 135th street. The one who you’ve ran on more times then you can count. The one who even through a nebulizer and two to three word sentences could still tell you a joke. That one.

“What happened?” I asked, expecting something respiratory. “She was Shot” he said. I didn’t believe him at first. “It’s true” he said, “It was a drive by. She was hit a couple times in the back.”

Some of you my know that I tend to work in the more “interesting” neighborhoods of the city. Stories like this are some what common, it could have been anyone. But that doesn’t make it any better. It just bothers me that this happened. It just doesn’t make sense  to me. I mean in some ways it does. I can figure out what probably happened. Maybe it was a case of wrong place at the wrong  time. Maybe she was involved with a dangerous group of people. I think it was a little of both.

It’s difficult for me to even pretend whats it’s like to want to kill someone. Maybe I’m biased on the issue? After all I work towards the preservation of life, not destruction. To think that someone could put that much time and effort into something so horrible is beyond me.

I have many opinions about violence, but no solutions. And there are many things I want to do, but don’t know where to start.  I’m just tired of it is all.

We are all in this together folks.

Play nice.

03
Feb
10

Frequent Flyer Benefits

By Jeramedic 8 Comments
Categories: Good Medicine
Tags: , , , , , , , , , ,

Is there such a thing as Frequent Flyer Benefits? Yes there is, and I’m not just talking about flying across the country on the cheap either.

In this business, “Frequent Flyer” is a semi derogatory term given to those patients to whom we see often. They are the homeless alcoholics, the poorly managed type II diabetics, and the lonely widow. Anyone who has been in the field for a few months can tell you who their preferred customers are, and they know their address and chief complaint by heart.

These patient are not just the habitual 911 callers, but are also the weekly scheduled transfers like dialysis and chemo patients. I recently had a discussion about this with a good friend of mine. He is an administrator at a mid sized ambulance company specializing in inter facility transfers, and he has been dealing with a rather problematic trend amongst the field providers. He told me that  many of his personal were not doing assessments on frequently transported patients.

When he would ask why they weren’t doing full assessments, he was met with poor excuses like “Mr Johnson has CHF, he’s always tired” or “Ms Conner is post CVA, she’s always altered.”

This is a very dangerous  practice. I know at times it is tempting to think of our frequents as static characters that we give rides to. But that is  just  not the case . And it should be reiterated that for the time on scene and during transport, regardless of your level. You are the person that is most responsible  for that patient. And not doing a full assessment is frankly irresponsible and could cause harm.

So you ask where’s the benefit’s? , why should I be happy to be transporting this patient for the third time this week? well because you are at a huge advantage to provide really good care. You’re even at a greater advantage then the patients primary physician.

If you transport Mr Fillips to and from dialysis three time a week, that means you do six assessments a week on the same patient. That’s twenty four assessments a month, and one hundred and forty four assessments  every six months!  Do you think his primary physician, let alone anyone assesses this man health twenty four time a month? Probably not. And if anything was out of the ordinary, who do you think would notice first? You would. That is of course if you did an assessment.

When treating a frequently seen patient, we should pretend that it is the first time we have seen them. Sure you know their name and medical history but that’s where the familiarity stops. Afterward ask yourself  how what you found compares to what you know? Whats different or new about the patients presentation?

EMS, despite what it might claim is not an emergency service. At least not exclusively. Our place in medicine is quickly expanding in many ways.  If we can lose the “trauma junky ” hero mentality, and embrace our true role as Health Care Professionals. Then we will not only benefit ourselves as providers and our industry, but also provide our patients with better care.

So the next time Mrs Miller starts singing “ca’mon ta my my house, ca’mon ta my house” Be true to your role. Be kind to your patients. And give them the respect and attention they deserve.

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