Thursday, September 27, 2012

Guns, guns, and more guns.

There are many posts going up about guns in EMS and allowing concealed carry on ambulances.


The ever wise Ambulance Driver

I am not going to take the time to research the numbers because I do not need to.  We see story after story of EMS personnel killed in motor vehicle accidents while operating ambulances.  We all know of personal friends that have had to switch careers because of work related back injuries.  I have had friends severely injured in falls and other hazards that are common to allot of the scenes we go to everyday.

Why the hell are we so focused on the "what if this happens" and the need to "be able to defend ourselves" of something that is so rare and unpredictable there is no way to prevent it 100%.  I now only know of one person shot at while  working EMS in the 17 years I have been doing it.  This on person was fodder in random violence and no firearm or amount of training could have prevented it.  Thankfully he is OK and escaped with a few minor injuries.  Would he have been able to respond if he had been carrying concealed?  Sure but, out of the shot out window in the back of a truck going hot he would have been totally ineffective with a sidearm against another vehicle.  All he would have done is put a lot of others at risk with flying lead.

We can decide to worry about the risks we can mitigate:

Back injuries are a needless thing and are caused by the carelessness of lifting mechanics.  You know those classes some of you are daydreaming in.  Daydreaming of how we can get concealed carry on the ambulance instead of learning something and applying it.

Vehicle accidents cannot be taken out of emergency driving but, proper training and risk mitigation can lower the numbers and injuries.  Maybe a proper priority dispatch system and an attitude change of fast and reckless driving.  This is by far the number one killer of EMS personnel, not a violent bystander or patient.

Instead of weapons we should be asking for Non-Violent Crisis Intervention training.  We should be asking for Verbal Judo training.  We should be asking for self defense training so when the time comes to run and someone wants to stop you from running you can persuade them to let you go.  If I remember right there was an incident in Louisville KY a number of years ago that killed a Paramedic and her partner.  When they entered a house they were shot and killed.  There is no weapon that could have prevented this and they did not know what hit them.  If arming medics was the answer why do we have Police Officers being ambushed and killed?  They are trained and armed to deal with that.

In my medium sized city we have had 66 stabbings, 63 shootings, 321 robberies, and 14 homicides so far this year.  464 incidents of violent encounters in the city and 1 against EMS, less than a .2% chance in 1 out of 17 years I can remember that EMS was targeted.  I know of 4 ambulance that have been severely damaged out of 15 trucks, 27% of the vehicles.  I am more concerned about 27% than the .2%.

We need to get out priorities straightened out and fix what we can.

Thursday, June 14, 2012

C'mon man, EMS style...

Clicky here for full story...

Low speed accident staged for insurance fraud.  Ambulance arrived and flew two patients that had minor injuries.  Patients became criminals and were arrested for felony insurance fraud.

I was not there but, the Trauma centers found minor injuries so I feel it is safe to assume someone needs some remedial training on assessments and when to fly.  To review here is some data from a study done earlier this year:

Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%

Those are the numbers on how accurate each indicator is on predicting major trauma.  If you feel the need to fly based on mechanism maybe you should contact the local National Guard Base and find out the availability of a Chinook or Blackhawk to fly the vehicle instead of your patient.  It would free up both HEMS resources and the local wrecker companies for the real work they need to do...

Wednesday, June 13, 2012

A Good Start

Six months ago last Sunday I completed my first six months as a Paramedic on the street.  Five of those months have been solo and it has been the most fulfilling six months out of all the years prior in EMS.  I have withheld treatments that in the end I kicked myself in the ass for withholding.  I have been called to the carpet by the armchair quarterbacks and came out of it better at charting.  I have learned how valuable and irreplaceable a strong EMT is when the shit hits the fan with multiple patients and no second truck.  I have learned a whole new way to practice medicine and remember why I thought this was the best job when I started years ago.  But, there is one lesson that I have learned that is the most important thing that cannot be taught in class.

Sometimes you have to go with your gut feeling.  Monday I responded to a call of a weakness and dizziness.  On patient contact I really was not given anything concrete to go with other than sinus tach, confusion, weakness, and hypertension.  History was a little concerning with three weeks worth of spells of vertigo still undiagnosed.  Gut feeling was CVA even though I had no clear symptoms with a FAST exam.  I went with it and was off scene in five minutes delivering the patient to CT in another nine.  Yes, patient contact to CT was 14 minutes.  On arrival those clear signs were beginning to show with facial droop and more pronounced left sided weakness than right side.  An awesome ER staff and Doc who trusts us and our field judgments started TPA within 70 minutes of onset of symptoms.  The results were a patient who had no deficits being transferred to the ICU later that evening.

I cannot begin to explain how rewarding and fulfilling it is to know you started a process that involved a whole bunch of people and it literally gave someone their life back.  If there is one thing I can suggest to a new paramedic or if I was allowed to share one piece of advice to others it has to be what my trainer told me:  "Sometimes you have to listen to what your gut says and run with it."  The next would be sometimes we do not need to inflict our skills for a best case outcome.  The only advanced skills I did on this patient were an EKG to rule out dysrhythmia along with an IV en route to the ER.

I am looking forward to the next six months and years to follow.  I have a full-time job in the works for the end of this year or beginning of next year.  I have been working full-time hours in a part-time position for the last six months and will be in heaven when I do not have to report to my current full-time job in the future.

Tuesday, June 5, 2012


There is a Jems article comparing EMS skills to a football play...

I cannot begin to portray how demeaning and appalling that I find this article to be towards EMS as a whole. Maybe it was wrote and published with good intentions. Maybe I am taking it in the wrong context. I do not know but it is not how I want my profession portrayed for a number of reasons.

I can teach a monkey to perform a football play and run through a certain gap in the line. I can teach a monkey to intubate a patient because it is repetition and muscle memory. That is where the similarities stop. What I cannot teach to a monkey is the discretion that it takes to be a Paramedic. Fourth and long is not that big of a deal in football, punt the ball and try again later. Fourth and long is life and death in EMS and that is where the playbook is usually of no help.

I read through the article and it a very little to do with calling a play and everything to do with laziness. Not bringing in the cot with the rest of the equipment, when did the trend happen that the cot is left out in the truck? The most important piece of equipment that we cannot function without or transport the patient is the cot and we are primarily a transport service after all. I can do a lot of things for my patients but, transport in a timely manner means more for a critical patient than anything else I do. I thank God for my firefighters and the assistance they give me when they are there but, I definitely do not rely on them to get my cot in the door.  They are first responders not hose or cot jockeys.

Most Paramedics would take the airway kit, drug box, and monitor without hesitation on a dispatch like this. The mindset would be doing as much as possible without wasting time but, they left the cot outside...

Did this trend start when Paramedics and EMTs decided that they held the power to determine if this person's 911 call was legit? Maybe quit complaining about the last patient and how many cars were in the driveway, yes it is annoying, and start treating every call as an emergency until proven otherwise. If they had taken nothing in more than the cot, they would have been able to get this patient to the ambulance in a timely manner. Personally I have scene times of 5-8 minutes on critical runs because I have a cot with me and can do the rest while going down the road. Stroke symptoms, load and go…STEMI on the monitor, load and go…Respiratory distress or failure, load and begin treatment. These are the fourth and long situations of EMS, and without the ability to transport an audible is not available.

This scenario was doomed from the start because of an EMS crew that came in the door unprepared for a critical patient. The debriefing should have had nothing to do with a pep talk about football and everything about an ass chewing for being unprepared without the ability to begin immediate transport, an ass chewing for the Paramedic that did not take charge immediately with scene management. Maybe a hose drill for the Paramedics is what is needed but, instead of a hose use the cot.  A few trips up and down the stairs to the roof lugging a Stryker Power Cot will create a lasting impression to treat the cot a little more like American Express and never leave the truck without it.

Saturday, May 26, 2012

Memorial Day

John 15:13 "Greater love hath no man than this, than a man lay down his life for his friends."

Time to drop your rucks and relax awhile, we got the next few patrols so you may rest in peace Brothers. From the cold of the Potomac River to the mountains of Afghanistan, and everywhere in between, you will never be forgotten and we will never allow you sacrifice to be downplayed or dismissed. 

Take a moment to pay respect to those that have fallen to allow all of us to have a day off of work.  Without those of our Armed Forces that gave the ultimate sacrifice none of this would happen.  That is the true reason for the day.

Wednesday, May 23, 2012

What the hell...

Video Here

Watch the video first. 

Each of them, for their own reasons, concluded that the wars they fought in were wrong, and so they marched together today, about four dozen veterans of the wars in Iraq and Afghanistan, each prepared to return their Global War on Terror medals in symbolic protest. Soldiers like Sgt. Jacob George, who did three tours in Afghanistan.

"I do not feel like the intentions of the overall mission matched my intentions as an individual and most of the people who served," said George. "I am willing to give them back even though it is a very emotional thing for me."

"I was in Iraq in '03 and what I saw there crushed me," said Ash Wilson. "I don't want us to suffer this again, and I don't want our children to suffer this again. So I'm giving these [medals] back."
One by one, 45 veterans spoke of their own anger or pain, and each turned and threw their medals toward McCormick Place. They had asked that the NATO representative formally accept them. That did not happen.

"I'm one of 40,000 people that left the United States Armed Forces because this is a lie," said one veteran.

"I will not continue to trade my humanity for false heroism," said another.
Vincent Emanuele is from a multi-generational military family. Returning his medals, he says, is about sending a message to the world, but is also cathartic.

"For many veterans to deal internally with what it is we have experienced overseas and then to come back and to make amends for ourselves," said Emanuele.

"This medal right here is because I'm sorry - I'm sorry to all of you," said Aaron Hughes. Hughes, who served in Iraq, helped organize what became a moment on an international stage - a moment meant, he says to show disdain toward policymakers and not the men and women still fighting.

"I love all my brothers and sisters that are in Afghanistan still, and I hope they get to come home soon," said Hughes.

And I bet everyone of the 45 or so were the only ones drafted in the last 40 years.  You signed up for a reason and when you were called upon to do your job, not duty since you have no idea of the meaning of the word, you fucking cried and said you never signed up for this.  You were the type of Soldier, Marine, Airman, Sailor, etc that fucked up a unit and you never were able to make it in the military so you got out.  You got out and then fucking cried about it and how horrible it was.  But, you are the first ones standing in a line to get "what they owe you" all while speaking out against everyone of us that were there and did what was asked of us.  I see your type everyday I am around liberals...

Do me a favor, pin the medal to the only copy of your DD214 and toss that over the fence with a note saying you give up all VA benifits and I may think of you as a person again.  Until then you are lower than what I left in the port-a-johns at FOB Warhorse and other locations except, that material was at least good for fertilizer...

As I used to tell my privates, feel free to go and suck start a shotgun since it may listen to your crying...

Another piece of free advise to those that may want to join the military in the future.  You may some day be called upon to do your job in combat.  Do some soul searching before you take an oath and ask yourself one simple question; Can I go to another country and kill someone that my government says is a threat and an enemy.  If you cannot answer that, without any doubt, as a yes then become a politician and try to make a difference, stay out of the military.  The military is not a free ride through college or a good looking uniform that will get you laid.  It is the greatest fucking machine on earth with two purposes.  The first is peace by presence of force, we will fuck you up if you mess with us.  The second is to be the most efficient combat machine in the world when the time comes.  That time is not for anyone in uniform to decide, you also do not get to quit and go home when that time may come.  When you cry about it be prepared for one of us out there to possibly shove that medal up your ass...

Pull your weight...

As a part timer I get the privilege of working with many different full time people from EMTs, EMT-As, and Medics.  I call it a privilege since I get to learn from all, it really helps to round you out as a Medic when you see all the different ways to do everything.  There is a downside though.

Enter into the scene the 20 year, 50 something, career EMT that has no plans to go further or do more.  The one that hates any type of change and thinks that as a 20 year employee they are the one in charge of the truck and responsible for everything.  That one person that feels the young kid can do all the work, all the charts, all the driving unless they are doing patient care.  The, I'm down four charts at 4am 21 hours into a shift that has not involved any sleep for me, I'm not taking that BLS patient because they said their pain was a 7/10 after being woke up.

This is after you checked out the truck, while they slept.  This is after you did all the station chores, while they slept.  This is after you restocked after all runs that you did the patient care and chart on, while they played on the internet or slept.  This is after you gave the truck its evening bath, while they watched TV and went to bed.  This is Had a partner the other day that gave me yet another first since switching from an EMT to a after a whole day of listening to complaining of how the manager is ruining the service.  At least I got three hours of quiet to catch up on charts before the last run they refused to take.  Fast forward 6 days and you get to repeat it all over again...Suggest that they pull their weight a little and you get, "I was pulling my weight before you were born sonny." 

I wonder how you seasoned medics handle someone like this.  I do not like to make waves with people who have been there longer than me, I believe in a little courtesy for seniority, I am a union man in my real life after all.  But, enough is enough, and believe me, WWIII happened for the sonny comment; I pulled my weight in the sands of Iraq while this asshole sucked off of his co-workers tit.  Do not get me wrong no one owes me shit, I will not be disrespected like that by anyone…