The EMT Spot

No One Can Care For You

administrator — Mon, 06 Feb 2012 22:46:40 +0000

Someone else can be committed to training you to an acceptable standard.

Other people can require you to hold the proper certifications and minimal requirements to do the job.

Field instructors can demand that you demonstrate a minimum level of competence before you are allowed to work autonomously.

Quality assurance managers can confirm that you document acceptable treatment plans.

Administrators can monitor your adherence to policies and procedures.

Governments and institutions can demand your attendance at continuing education classes.

Almost everything about your performance can be demanded and confirmed, except for your compassion.

Nobody can force you to care.

Nobody can demand your heart-felt effort or your empathy or your genuine kindness. If you choose to have it, it is your prerogative. The industry can demand that you perform a service, but nobody can command you to serve. You can’t be ordered to bring your passion, your spirit and your individual, unique contribution to your job each day.

You have to choose to do that on your own.

That’s what makes it so valuable. …That’s what makes it priceless.

I’d like to know what you think about that.

Introducing the NAEMT

administrator — Sun, 29 Jan 2012 23:56:28 +0000

If you are an EMT of any rank or variety, I’d like to introduce you to a friend that you may not know about. For your entire career in EMS, you’ve had a friend who has tirelessly advocated for your well being, silently worked behind the scenes to increase your pay and benefits, improve your educational standards and direct public policy in your best interest. When it comes to getting good stuff done for our industry, you have two choices you can join the chorus of disgruntled coworkers who bemoan the plight of over-worked and underpaid EMTs, or you can join an organization that has dedicated itself to making real change, every day, for you.

If you haven’t guessed yet, I’m talking about The National Association of Emergency Medical Technicians.

The NAEMT has been working had for you for a long time. They’ve advocated for you for over thirty years now. Today…right now, while you are reading this, someone from The NAEMT is working hard to make your career better. If you’ve ever thought to yourself that EMS needs a united voice and the local and national level, The NAEMT agrees, and they work to be that voice. If you’ve ever been concerned that EMS lacked the national representation that police and firefighters enjoy, The NAEMT agrees, and they are working to create that representation.

OK Steve, But What Does The NAEMT Actually Do?

We are an occupation of type-A, action oriented, individuals. Lot’s of organizations talk about advocating for the street level EMT, but what does the NAEMT actually do? In short…they do a bunch. Here’s a more detailed list:

They promote a pro-EMS legislative agenda through mail campaigns, political action and organizing large scale political events like EMS On The Hill Day. From improving the quality of EMS care to supporting military medics and honoring fallen EMS providers, there’s a long list of all of the legislation that the NREMT is directly promoting through one political action or another.
They promote fair compensation and benefits, actively seeking pay standards and benefits packages that reflect the true responsibilities of an EMS professional.
They create high quality EMS education programs that frequently become national standards for EMS training. These include Prehospital Trauma Life Support, Tactical Casualty Combat Care, Advanced Medical Life Support and Emergency Pediatric Care. Have you taken of any of those classes? Yeah…NAEMT did that.
They teach the instructor courses for all of the above mentioned classes.
They provide sponsorship and support for EMS educational forums like this one, EMS1 and EMS World.
They recognize providers who go above and beyond to advance the cause of EMTs around the nation with awards of excellence.
They hold a meeting every year (free for NAEMT members) to discuss the current state of EMS and develop goals and a plan of attack for the coming year. If you’d like to be a part of the largest group of EMS providers anywhere, coming together to support the cause of EMTs and EMS around the globe, you my want to look into becoming an NAEMT member.

What Does Becoming a Member Do For Me?

While there are a whole bunch of member only discounts and giveaways, the first and most important reason to join NAEMT is to be a part of the largest collective voice of EMS advocates anywhere. When you join NAEMT you demonstrate support for the association that supports you, the EMT. The NAEMT is a strong voice for change in EMS because of the stregnth of its membership. The NAEMT represents the power of thousands of EMT voices speaking as one. That association needs your voice too.

You’ll also receive a host of member benefits that are worth far more than the $40.00 that you’ll spend when you become a member. If you take advantage of even a small fraction of the discounts and giveaways that NAEMT offers, you’ll more than cover your membership dues.

I hope you’ll consider becoming a member of The NAEMT. They are big supporters of this blog and others like it.If you enjoy the type of information presented here at The EMT Spot, you should thank my partners at The NAEMT. If you’ve benefited from quality education, attended a good conference, read a great online blog, heard about some beneficial legislation being passed or taken part in a grass roots EMS effort, the chances are pretty good that the NAEMT had something to do with it.

You could put membership off another for another day or another year, but why not do what the NAEMT does for you everyday. Why not take some action right now. Join this organization. Your voice is powerful. Your action is necessary. You need the NAEMT as much as they need you. Click this link and join. I’ll see you at the next meeting.

Objectivity and Patient Care

Steve Whitehead — Sun, 22 Jan 2012 23:58:35 +0000

A Guest Post by Sean Fontaine

I love posting articles controversial enough to warrant a disclaimer. Today I have the pleasure of bringing you another post by guest author Sean Fontaine. Sean is a graduate of Regis University and a Firefighter / Paramedic for The South Metro Fire Rescue Authority. He lives in Denver, Colorado with his lovely wife Oz and their two sons Jonas and Axel.

Today, Sean throws down the gauntlet on an issue that must be addressed by every emergency caregiver; the delicate balance between delivering objective, impartial medical care and the urge to interject our emotions into the often emotional drama that is emergency medicine. Can you make real emotional connections in the process of administering medical care, or does the emotional aspect of the job directly impact the effectiveness of your care? Some of us may address this dilemma only in our own private thoughts. Others may wish to publicly declare their position. To that end, here’s Sean…

Let me preface this post with the explanation that this topic comes straight from my discussions with paramedic school students and co-workers and the differing/agreeing viewpoints that resulted from those discussions. These are my opinions (not Steve’s) and I know full well that there are many of you out there that will disagree and some that will think I’m an insensitive ass. So be it, we’re here to listen to different viewpoints and think through them for ourselves, deciding in the process what our own thoughts truly are on a given subject.

The Argument: Your level of objectivity effects the quality of your patient care.

I contend that when we emotionally care about our patients we become subjective caregivers and as such render subjective care, transitioning to reactive rather than proactive medicine.

This topic has come up with co-workers when discussing my history of sick and dying pediatric patients, traumatic or precipitous delivery OB calls, and violent sexual assault calls over the past 10 years. (In comparison to the rest of my calls.) In addition, this topic inevitably came up when I spoke with last year’s paramedic school class at a local teaching institution. (I was speaking on the subject of pediatric death and dying, prior to their PALS scenarios.)

During those instances, I stated with no intended malice, that a sick, dying or dead pediatric patient demands the same mental cognizance as a sick, dying or dead adult patient. As such, I see no reason to change my treatment or mindset because the pediatric patient is viewed as “innocent” or deemed “more worthy” of our efforts by some caregivers who then become emotionally involved with the patient. All patients are “worthy” of our full and complete efforts and treatment. That’s our job.

Once we take that step and become emotionally involved with our patient, I believe we cease to observe and treat to the fullest extent of our ability. Hence the previous statement regarding the rendering of subjective and reactive medicine, rather than focused, proactive medicine. I believe that we are paid to think through patient’s current signs and symptoms and consider differential diagnoses, treatment options, appropriate destinations and the most appropriate continued course of treatment. Then, through the course of these actions…we care for our patient by acting in their better interest. We act as their “advocate” if you will.

As you can tell by my verbiage the line as I see it is, “Caring for your patient equals proactive/objective care, whereas caring about your patient equals reactive/subjective care.

Don’t think that I don’t appreciate the weight of this argument. I have had numerous sick, dying and dead pediatric patients with a myriad of outcomes, some of these patients have been carried in my arms to the ambulance, as I have likely carried my own children at some point. However, in acting as our patient’s advocate, we need to operate without our emotions. It’s part of the cost of doing business for us as caregivers. That’s not to say that I don’t think about the potential gravity of the call, I just do it later.

Thinking through the call later is good for multiple reasons, such as addressing learning points, emotionally dealing with the gravity of the call, and ensuring that the crew are dealing with all associated issues in a positive manner. There is an agreement made when choosing this profession and this unspoken agreement is what defines that “mental cognizance” we are asked to bring on each call. This “mental cognizance” doesn’t recognize age, sex, color, religion, level of income, level of education or attitude. Every patient is deserving of our best and most objective efforts. The great part about this agreement though is that it’s nonbinding. We can opt out at any point and move on with our lives.

As I said earlier, I appreciate the weight of this topic. I do not intend to come across as callous in my stated opinion. I also don’t tread through unfamiliar territory. Quite the opposite, this is territory I’m quite familiar with and fully appreciate after some time running these calls. Additionally, I have come to a personal understanding about how to best work through these emotional issues, both during and after the call, to render the best possible objective patient care.

Now it’s your turn:

Thanks Sean. Now I’d love to hear what you think. Can emotions and objectivity be separated during the course of patient care or do they inevitably affect your care? Leave a comment and let us know.

Related EMS Awesomeness:

Five Tips for New Paramedic Students

Overcoming EMS Burnout

Connections

Coping With Grief and Tragedy

One EMT Can Make A Difference

Great New Hands Only CPR Video

administrator — Fri, 06 Jan 2012 12:00:35 +0000

I have to give credit where credit is due. The British Heart Foundation recently released a public service announcement video staring tough-guy actor Vinnie Jones. (See Lock, Stock and Two Smoking Barrels, Snatch.)

This might be the most clever medical PSA I’ve ever encountered. The British Heart Foundation folks have figured out how to get ideas to spread in the 21st century. First, make them simple. Second, make them memorable and third, whenever possible, make them funny.

This is the kind of thing that people will post on their Facebook pages. Once they do that, you don’t need to distribute the idea any longer, people will do it for you.

Nice Job Guys.

See other videos:

It’s A Calling

Remember Two Things: Saying Goodbye

Passion: How Sam Able Makes a Photograph

Remember Two Things: Sepsis

What Motivates Us Really?

It’s A Calling

Steve Whitehead — Wed, 04 Jan 2012 21:26:12 +0000

I really enjoyed this video that was uploaded today over at EMS1‘s ParamedicTV. I’ve seen a few of these videos come and go over the years and I’ve even contemplated putting one together myself.

What I appreciated about this video was the focus on the commitment and compassion of EMS providers as well as the multicultural scope of the photos. Some of these videos get a bit over the top with the “hero”aspect of the job…a characterization that I’ve never been entirely comfortable with.

I think this video gets it right and I’d like to share it with you.

ParamedicTV is powered by EMS1.com

See other videos:

Remember Two Things: Saying Goodbye

Passion: How Sam Able Makes a Photograph

Remember Two Things: Sepsis

What Motivates Us Really?

New EMT National Registry Phone App

administrator — Mon, 02 Jan 2012 15:42:57 +0000

Here’s some good news for EMT’s studying for the National Registry exam. The development team at The EMT Advantage has partnered with the phone app design folks over at Code3Apps and put together a phone app that will let you simulate the NREMT Basic exam right on your cell phone.

Using the same authors that write the actual questions for the Registry exam, the NREMT Simulator allows students to simulate what it looks and feels like to take the National Registry exam. The simulator is different from other Registry study tools in a bunch of ways that EMT’s preparing for the exam will find insanely useful.

The phone app includes:

Questions pre-calibratd to National Registry passing difficulty
Subject matter that spans the entire National Standard Curriculum
Questions developed by the same individuals who write the Registry exam questions
Pass / Fail estimations in each of the six Registry subject categories
Detailed post-test feedback on user results with question break-down

You can pick up the NREMT Simulator for your Android smart phone in the Android marketplace right here. You can also find it on your droid by searching the marketplace for NREMT Simulator.

Iphone users can get it at the iphone store right here, Or search for NREMT Simulator in the iphone store.

There is also a version available for the Kindle Fire. You can download any version of the app for $4.99.

Do you want to know if you’re ready to pass the National Registry exam? When you think you’re ready to tear it up, download the app and find out for sure.

Freedom to Fail

administrator — Tue, 06 Dec 2011 19:42:29 +0000

“There can be no real freedom without the freedom to fail.”

-Eric Hoffer (American Social Writer)

But can we really? I mean, really fail. In the course of delivering emergency care can we completely fail?

I imagine that somewhere at the core of each and every one of us is a secret fear that the next call, the next major incident, the next patient contact might be the one where we fail. I think we all carry around with us the fear of a massive, public, ugly failure in the course of our care.

I say that because it’s entirely plausible that we will experience one of these failures in our careers. They happen all the time. They happen more frequently than we want to admit. And I would like to assert that we are better caregivers when we can put that fear aside.

What does your organization do to help resolve that fear? What does it do to feed it?

What your organization does to respond to critical failures in patient care will determine a lot about how free their personnel we feel to go out and practice good medicine. It’s worth thinking about.

What is The Parkland Formula?

administrator — Fri, 02 Dec 2011 00:18:55 +0000

Here’s a (fairly) simple calculation that you can use to figure out just how much fluid you should be giving to your burn patient. The Parkland formula is both simple and useful. It not only gives us a good general idea how fast we should administer that first bag of saline enroute to the E.R., it’s also a great reminder of an important fact of burn care:

Burn patient’s need lots of fluid. …How much?

Let’s review the Parkland Formula and figure it out.

The Parkland Formula was born in 1968 when emergency room physician Charles Baxter realized that his critical burn patients needed massive amounts of fluid in the first 24 hours of treatment to remain hemodynamically stable. Working out of Parkland Memorial Hospital in Dallas, Texas, he and his fellow physicians began experimenting to figure out a fast way to know just how much fluid was enough.

The result was the Parkland Formula. Used today almost universally, in burn centers across America and around the world, it has become a standard of critical burn care. And, yes, you can do it too. Don’t get nervous about your protocols, your local E.R. physician knows the formula.

The Parkland formula begins with a rough calculation of the patients total body surface area burned. That is to say, what percentage of the patients total body surface area is involved in the burn? To come up with that number we can use a few techniques. There’s the palm rule (or palmar rule) and the rule of nines. Feel free to brush up on both. We’ll wait.

OK, now that we know the total body surface area burned (TBSA) we also need to estimate the patient’s body weight in kilos. This is a relatively simple matter for just about everyone in the entire industrialized world…except within the United States. Here in the states we insist on teaching, learning and using the English standard system of measurement, which gives all of us in the medical field fits. There are a few good techniques for learning to estimate body weight in kilograms. You may want to review those too.

Now back to our Formula.

With the Parkland Formula, we’re only estimating second and third degree burn involvement. First degree burns don’t tend to create the massive fluid shifts that we see in second and third degree burns so we don’t administer fluids to them nearly as aggressively as we do for our more significant burn patients.

With that said, let’s take a look at the formula and then let’s use it in a couple of real burn scenarios. The calculation looks like this:

(4 * Patient’s weight in kilos * Percent of body area with second and third degree burns) = Amount of fluid to administer in the first 24 hours after burn injury.

Fluid to administer in first 24 hours divided by 2 = fluid to administer in first 8 hours

Finally, if we divide the final number by 8, we’ll know about how much fluid our patient should receive from us before we reach the hospital (in most urban EMS systems).

Don’t panic, it isn’t as complicated as it sounds. Let’s try it out.

A 220 pound male has second and third degree burns on his whole chest and abdomen, the front of both legs and the front of his right arm. Using the rule of nines we determine that the patient has approximately 40% of his total body surface area involved in the burn.

Chest + abdomen = 18%, whole leg = 18%, half of one arm = 4.5%. 18+18+4.5= 40.5%

We also calculate that his 220 lbs. puts him at exactly 100 kg. 220/2.2=100.

For this patient, our Parkland calculation would look like this: 4*100*40=16,000.

This patient will need 16,000 ccs of fluid, or 16 one liter bags in the first 24 hours of care. Divided that in half and we see that we’ll need to administer 8 liter bags in the first 8 hours. This patient needs a bag of fluid for ever hour of care that we provide.

Start your time calculation at the estimated time of the burn injury.

Do you feel like you have a handle on that one? Let’s take it up a notch.

This time lets take a 138 pound female with second degree circumferential burns to both her legs. Let’s also include her full back and the back of her head in the affected burn area. That would be 57.5% of her total body surface area.

Upper and lower back = 18%, Left whole leg = 18%, Right whole leg = 18%, back half of the head 4.5%. 18+18+18+4.5 = 58.5%

Now let’s convert her body weight to kilograms. 138 / 2.2= 62 kilos (more or less).

Now we’re ready to do our Parkland formula. 4*58*62= 14,384. With our first patient, many of us could manage the math in our heads. For our second patient, most of us would prefer a calculator near by. Luckily, most of us carry a cell phone with a calculator function in our pockets. Make good use of it.

Our burned female will need about 14 litters of fluid in the first 24 hours of care with 7 coming in the first 8 hours. Between 800 and 900 ccs will do her just fine in transport.

We can see a few good uses for the Parkland formula. First, by playing with the calculation now, on hypothetical patients, we remind ourself of an important fact of burn care. Burned patients need a lot of fluid. Second, if we’re nervous about opening up that IV bag during transport, it’s simple enough to be used right there in the back of the medic unit to make a quick guess about how much fluid we should be giving enroute to the ER.

It’s important to note that the Parkland formula isn’t the last word in a burn patients fluid resuscitation. The formula is a fast way to develop a good idea just how much fluid a patient will ultimately need. As patient treatment progresses, unine output and vital signs will give care givers more accurate information about the effectiveness of the ongoing fluid resuscitation efforts. Retrospectively, the formula tends to be accurate in 70-80% of cases. Others will need adjustments along the way.

There you have it. Play with the Parkland formula and let me know what you think.

The Problem With Indifference

administrator — Mon, 21 Nov 2011 01:04:31 +0000

“The opposite of love is not hate, it is indifference. The opposite of art is not ugliness, it is indifference. The opposite of faith is not heresy, it is indifference. And the opposite of life is not death, it is indifference.” -Eli Wiesel (Holocaust survivor and author of the book Night.)

Sometimes we equate behaviors like anger and frustration to burnout. I often disagree. It isn’t the angry EMS worker or the frustrated employee that concerns me, it’s the indifferent one.

Anger is OK. Don’t be afraid of your anger or the anger of others. Anger means that we sense injustice and we care enough about it to want to take action. Angry people have done some great things. As long as we find respectful and appropriate outlets for our anger, it can be a very powerful emotion.

The same goes for frustration. Frustration is the birthplace of innovation. Frustration is often what we experience right before our breakthroughs. Frustration tells us that we are still ingarged and we haven’t given up.

Neither of these are burnout.

Burnout is the point when we no longer care. Burned out individuals may still see the injustice. They may still sense the need for a breakthrough. They may even be able to define it. The difference is that they no longer care.

Indifferent caregivers are dangerous. Avoid them like the plague. You have permission to feel angry. You have permission to feel frustrated. You never have permission to be indifferent.

If you find yourself at a point of indifference, it’s time to move on.

What do you think?

Remember Two Things: Saying Goodbye

administrator — Tue, 15 Nov 2011 17:37:31 +0000

My latest Remember Two things video is posted over at EMS1.com. In this episode I discuss a crucial moment in patient care that is often overlooked. I’m talking about the moment we say goodbye to the patient after we’ve dropped them off at the hospital or their designated destination.

It’s an important moment because it’s an opportunity to make a very real, human connection with our patient and leave them with a positive impression of their experience with us and our service organization.

ParamedicTV is powered by EMS1.com

There’s an interesting little bit of behind-the-scenes information about how I started the tradition of saying these two things before I left a patients room. I picked up the idea of always saying that I was glad to be of service to the patient early on while working at Pridemark Paramedic Services.

Jeff Forster, the organization’s CEO, was the first EMS leader I encountered who really challenged his people to take their service level up a notch and maintain a patient-needs-first focus.

Years later I had a partner named Will Dunn. Will went on to be a popular EMS instructor in the mid-west region as well as a paramedic supervisor and education coordinator for Eagle County Ambulance District.

Years after our partnership, Will and I were having lunch together when he brought up how he’d picked up on my habit of leaving each patient with a hand-shake and warm goodbye. He told me that he had been doing it ever sense our partnership. I respected Will as an excellent paramedic and I was proud to know that I had influenced his care in that way.

Then he told me about how he always asked if there was anything he could do for the patient. I really liked the idea and started trying it out immediately. I’ve been doing it ever since.

I was influenced by Jeff, then Will learned something from me and then I learned something from Will and now, perhaps, you can learn something from all of us. It’s amazing the way we influence each other, isn’t it? I hope you’ll try this out and I hope you enjoy the video.

Leave a comment and let me know how it goes. It’s been a pleasure being of service to you today.