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.