This is one of those things that we have no choice but to address in every system on just about every call. How to we get the patient to the pram? When is it OK to walk them?

It seems like this subject got rolling on Justin’s (THM) blog when EMS types from around the country started sending him feedback about his role in the documentary film, The Chronicles of EMS. He was surprised by the volume of comments about him choosing to walk patients to the ambulance.

Unfortunately, I understand the surprise of some of the Chronicles viewers. I once worked in a system where allowing a patient to walk to the pram was taboo. Allowing EMS providers to use their judgment was also taboo so the no-walking policy went hand-in-hand with the general management style.

Now I work in  system much like Justin’s. Our operational guidelines give care providers much more leeway. Using good judgment, doing things that make sense and being accountable for the decisions that you make are all given a higher priority than strict adherence to thick policy manuals that outline every aspect of operational minutia. (Whoa, that was quite a mouthful.)

When I transitioned from the carry-everyone-to-the-pram mindset to the do-what-makes-sense mindset it took a bit of adjustment. Here are a few of the things I’ve learned about walking folks to the bed or even the ambulance.

1) Ask the patient about the last time they walked. Have they been sitting for a long time or have they been up and about? If they were walking around, how did it feel? Have they had any dizziness or ataxia? If so, you might want to rule out walking them.

2) Don’t even try it if the patient has potential cardiac, respiratory or hemodynamic instability issues and be cautious with altered mental states (including intoxication.) It’s important that your decision to walk the patient be guided by common sense.

If you put a c-collar on them for a potential spinal injury then you shouldn’t be walking them to the backboard. If they’re post-ictal, they shouldn’t be walking down stairs. Think about whether or not walking and exertion could make their condition worse. If you don’t feel confident, don’t road test them.

3) Stand them first, then walk them.When your ready to walk the patient, reach down and grab their pulse. Then ask the patient to stand. (Not walk.) Let them stand and get their bearings for a few seconds. Feel their hearts response to the positional change. Watch their expression and skin.

If anything doesn’t look right, ask them to sit back down immediately. Figure something else out. If everything looks OK and the patient reports feeling fine ask then to walk with you but keep that hand on their pulse until you are comfortable that they’re good to go.

4) Spot them. Just like a gymnastics instructor. Stand in a position where you can catch them if they loose their balance. If the patient needs to navigate some stairs, position someone above and below and watch them close. If the patient is heavy, you may need a couple people to help you. And if the patient does fall, remember that you your role isn’t to catch them but to help them to the ground.

Use you medical judgment and don’t get complacent. Walk the patient when it makes clinical sense to do so. If you’re walking your patient out of laziness, you’re bound to end up with some ridiculous policy forbidding you to do it anymore. Be smart and those policies won’t ever be necessary.

Now it’s your turn: Does your organization have a policy regarding waking patients to the pram? What guidelines do you use when making this decision?

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The Greatest Generation

“Success is to be measured not so much by the position that one has reached in life… as by the obstacles which he has overcome while trying to succeed.”

- Booker T. Washington

With multiple premiers of The Chronicles of EMS and a wave of enthusiasm from the EMS Today conference in Baltimore, the future of EMS looks bright, blindingly-bright. I’m incredibly optimistic about where this crazy experiment in EMS is headed, but I also see some big hurdles in our path.

Put on your shades and let’s talk about what I feel are the five biggest challenges to EMS reform.

1.) We’ve been talking a lot about unity and standardization, but individual EMS systems are unique in every way. How do you influence standardization and still allow for the tremendous leeway required for EMS agencies to be optimized for the communities that they serve? Can EMS agencies be different in geography, financial resources, administrative structure, culture, call volume, compensation and certification/education level and still find enough unity to advance the profession together?

2.) Today’s EMS systems are run by local agencies. A collective of public, private and third party agencies, guided by medical directors who maintain autonomous control over the care given in their system. People in positions of power and influence are reluctant to sacrifice control to larger concerns. How do you convince local power brokers to relinquish control over standards that they currently establish and oversee as they see fit?

3.) How do you encourage unity without creating conformity and stifling creativity and innovation?

4.) Mother Teresa once said that she would never attend an anti-war rally, but if you ever organized a peace rally, she’d be there. Will we gain more by rallying against the things that are wrong with EMS or supporting and expanding on the things that are right?

5) Emergency room physicians and hospital administrators have a tremendous amount of influence over how EMS is conducted. They also profit from the current inefficiencies in the U.S. EMS system. How should we encourage hospitals and physicians to support the idea of alternate transport destinations when they are the ones who profit from patients being delivered to the E.R. Why would U.S. ER Physicians support paramedics making doctor’s appointments, transporting to urgent care facilities and leaving patients at home when it takes revenue from their pockets?

There are good answers to all these questions. Before EMS 2.0 can blossom these questions will need to be answered.

What are your answers? (Note: If I get a large enough response from the blogging community, I’ll create a follow up post to link them all together.)

More Insanely Good Stuff:

Passion Counts

6 Reasons Why You Should Be A Better EMT

Don’t Be A Jerk

The Ultimate EMS Protocol

EMT Basic Skills Are Not Basic

I’m not scared of being held accountable for the medical decisions I make. I feel that I tend to make fairly good decisions, thank you very much, but the legal process can be expensive. And let’s be honest…because this is just you and me talking right? Sometimes the right thing to do is far from clear.

In a court of law, everyone is allowed the benefit of months of preparation, and then days and weeks are spent mulling over decisions that were made in real time. In EMS, real time moves faster than you might think. And good, well meaning, experienced paramedics labor to do the right thing.

Such was the case on May 24th 2008, when my friend was called to the home of man who wasn’t answering questions appropriately. Gerald Schlenker, a quirky resident of Arvada, CO, was admittedly a bit drunk when he walked back home and went to bed in his own bedroom.

He awoke to the Arvada police department in his apartment. They were there to arrest his roommate for his role in some sort of disturbance issue and they wanted him to answer some questions as well. He clammed up. He refused to say anything except rude and non-sensical statements. That’s when my buddy got involved.

Have you ever been in this situation before? Someone is drunk in their own home. They may or may not have initiated a call for help. Now they want to stay home. What are our options?

Frankly I can see this guys frustration. You find your way safely home, you go to bed and you wake up to a bunch of police officers in your home, wanting answers to questions about who you are and what you’re doing. I could see being pretty pissed off.

I can also see my friends vantage point. (All to well.) The guy won’t answer basic orientation questions. How can you possibly allow him to refuse your care? How can you document that he’s competent and able to care for himself? Is he really safe at home? Where does your need for documentation end and his human rights begin?

My friend opted to transport. If I was in his shoes, I could easily see myself making the same decision. Then Mr. Schlenker got downright belligerent. He eventually needed to be restrained. And then he was sedated. At the E.R. he was eventually granted a psychiatric evaluation. He sobered up, cooperated, and was released the next day. Then he was sent a $6,000 bill for his troubles.

As you might imagine, Mr Schlenker is suing everyone involved, the police department, the hospital, the ambulance service, and even my friend, the paramedic. He made a decision that he felt was in the best interest of the patient and now he’ll need to defend his actions in court. He’s a great paramedic. I’m certain he gave Gerald outstanding, compassionate care. He did everything to ensure his safety and well being. Sometimes you just can’t win.

Maybe it’s my king-of-my-castle mindset, or my mid-west style patriotism talking here, but I’m inclined to give people a lot of leeway when it comes to allowing them to stay in their homes when they choose to stay. Removing people from their homes against their will sits poorly with me.

Sometimes I still do it. It’s my job. But I never like it.

Regardless of their medical condition, the potential for a dangerous outcome, their level of intoxication, or even their willingness to cooperate, I feel like people have the right to make bad decisions in their own homes. And it’s not our job to always fix it. I feel bad for everyone involved in this mess.

What about you? How would you have handeled this case. What do you use to guide your decisions when you’re trying to decide ifsomeone can stay home on their own?

Want More Articles Like This One?:

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What is The Duty to Act?

What is The Good Samaritan Law?

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Wrong Medicine

In the coldest February, as in every other month in every other year, the best thing to hold on to in this world is each other.

                    – Linda Ellerbee (American Journalist)

And what better way to bring the EMS world together than the Internet? February was full of news and fun at The Spot. I hid inside from the Colorado cold and wrote about how to set up an IV line firefighter style. I asked you if you knew what was in the last issue of Splatter. (If you subscribed you’d know!) We discussed tips for mastering the head-to-toe assessment and getting people to hang up their cell phones. The premier of The Chronicles of EMS was the coolest thing is the blogging world. And we explored credibility and redundancy before launching into two posts on hypothermia. (Specifically how to assess it and how to treat it.) Then we wrapped up with a few musings about what it means to be passionate and what it’s like to be a firefighter. My fingers bleed for you.

A bunch of other cool bloggers also joined it. Can you guess who talked about the difference between treating your patients and caring for them? Or things overheard on the ‘bolance, tips for attending EMS Today, ALS kills people, the shine factor, the need for evidence before assessing guilt, the telephone game, when did I start being dumb, responsibility and what is, what was and what should have been. What to know who said what? You’ll just have to click on the links and find out!

And I need to give a special welcome to two new(er) EMS blogs with a ton of potential. First, EMS twitter maven @MsParamedic launched a blog back in late 2009 that has really blossomed in the last few months. Check out Angle Wings (breathe deep first) and Medic Student: Lesson One. Not to be outdone, @Medic_Bella has a blog fresh out of the wrapper called Dirt Road Medic. Take a sample of This is Where I Come From. Nice work ladies.

 In other EMS news, an Ohio police officers dash-cam provided startling proof of how careful you need to be working in traffic. A UK paramedic refused to resuscitate a patient and then told a series of lies to cover his tracks.  A hero of a teacher tackled school-shooting gunman in Littleton CO within sight of Columbine High – Can Littleton schools get a break, please.  A hearing was held for the Mass. responder being charged with vehicular homicide after failing to yield for a pedestrian. A Pa. man trapped by snow dialed 911 10 times over 30 hours before dying in his home. QA few NYC responders were forced to dodge bullets following an ambulance collision. A South Carolina firefighter-paramedic was fired over a video he posted on Facebook of an exchange between two cartoon characters at a hospital. And two former Rural Metro employees pled guilty to starting a fire in a vacant apartment building last spring while on duty.

And lets not leave out the podcasts. Will The GenMed Show ever produce another show? They say yes, but the jury is still out. Good luck on the coming conference tour guys. Medical Author Chat spoke with Maggie Dubris, the author of Skels: A Novel. Myself and the boys in The EMS Garage talked about a few of the stories mentioned above.  The MedicCast dove into pediatric issues and The EMS Educast examined how to evaluate students in all three learning domains.

What a great month. Come back in March and see what cool stuff happens next. Thanks for stopping by.

I didn’t begin my career as a firefighter but I’ll certainly end my career as one. I think I always knew that was the case. I’m a firefighter for a lot of good reasons.

I’m a firefighter because I believe in the honor, the history and the tradition of the American Fire Service.

I’m a firefighter because after a decade of delivering paramedic care, I wanted something more.

I’m a firefighter because I love putting people in the back of an ambulance and taking them to the hospital, but I also love going inside buildings that are on fire, tracking down natural gas leaks, rappelling off stuff, sawing stuff, breaking stuff, checking out alarm panels and crawling through the mud on the bottom of a lake.

I’m a firefighter because I like the way a haligan bar feels in my hand, I like the way my helmet fits on my head and I like the way my bunker gear smells after it’s been in smoke.

I’m a firefighter because I don’t think CFO’s and investors should be making decisions about how I should care for my patients.

I’m a firefighter because it want a career and a retirement.

I’m a firefighter because I like to wave at kids and I like it when they wave back.

I’m a firefighter because I like being a part of a team and I like working with a group of well trained people who are moving towards a common, meaningful goal.

I’m a firefighter because I believe in physical fitness and I like the idea of making a personal commitment to remaining physically fit for duty.

I’m a firefighter because it suits me.

I’m a firefighter because my mother said I should be. (You should listen to your mother.)

I’m a firefighter because I feel our lives should be constant learning process and we should challenge ourselves to remain outside of our comfort zones.

I make no apologies for performing emergency medicine under the banner of the fire service. I’m proud to be a firefighter. I’m proud to wear the uniform. I’m grateful that I’m permitted to do the job. I wouldn’t want to do anything else.

Most of all I’m proud of the men and women who I’m privileged to work beside. They inspire me every day.

Read more stuff like this:

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Waiting Is Serving

For jobs that require skill, insight and good judgment (Like our job does.) passion counts. Passion is important.

For jobs that require artistic expression (Like our job does.) passion is essential. No artist ever became great without passion. Without it you may master the skill set, but you’ll never be great.

You may get the idea that you can be great in EMS without a love for the medicine. You’re wrong. You can love the bright lights and the sirens wail; you can love the authority, the status and the uniform; you can even love the people who do the job, but if you don’t love the medicine, you’ll never be great.

Adequate perhaps, but not great.

Now it’s your turn: What do you think?

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Credibility and Redundancy

6 Reasons Why You Should Be A Better EMT

Beware of Almost Good Enough

Five Rules For One Shift

Are You The Opening Act or The Rockstar?

In our last post we looked at some of the causes of hypothermia, both typical and atypical. Then we talked a bit about the recognition of the hypothermia progression and what patients might look, feel and act like as they progress through their hypothermic condition.

Now let’s look at some of the guidelines for treating our hypothermia victims.

On the surface, treating hypothermia might seem deceptively simple. The treatment of mild hypothermia often is simple. Bring them in, stop the cooling and rewarm them. But as we progress into moderate and severe hypothermia, things get more complicated. Here are 12 guidelines to consider when the patient is more than just a little chilled.

Stay warm.

As much as it pains me to make a statement this obvious, please forgive me. Hypothermia patients are often found in cold, wet environments. You need to be better prepared than they were to work in that environment or you may find yourself in a similar predicament.

Dress warm. Use layers and be prepared to work in the cold for alonger operational period than your best case scenario.

Remove the patient from the environment.

And stop the cooling process. In our rush to initiate more advanced warming techniques, we can sometimes forget about the basics. Remove wet clothing. Water conducts heat 25 times faster than air. That’s why water i so often associated with these events. If the patient is wet, from any source, to any degree, dry them.

If the patient is found in a cold environment, getting them out of the environment is a priority. Find a dry, warm place to initiate rewarming and treatment.

Don’t be fooled by your thermometer.

Most standard thermometers and some tympanic thermometers won’t read below 94 degrees fahrenheit. Do you know the lowest reading your thermometer is capable of producing? If not, you may vastly overestimate the patients temperature.

Assessments findings are a much more reliable indicator of hypothermia severity than an over-the-counter thermometer. Is the patient still shivering or have they stopped? How well is the patient mentating? Pay more attention to your patient than your thermometer.

Check the glucose.

Patients who shiver for long periods of time may be glucose depleted. To help them assist in their own rewarming process, a course of glucose may be indicated. Check the blood sugar and consult with your base doctor on the best course of glucose management.

Avoid rough handling.

Individuals in moderate to severe hypothermia stages become more susceptible to sudden ventricular fibrillation. Bouncing, jarring and rough handling may precipitate a deadly arrhythmia. Once the heart fibrillates, cardiac arrest is difficult to manage.

Also keep in mind that cold and frostbitten skin is very delicate. We should avoid rubbing or scraping the skin. Straps should be padded and hot packs and other active rewarming devices should never be laid directly against the skin.

Support the airway as gently as possible.

Moderate to severe hypothermic patients may breath slow and shallow. We are accustomed to managing the hypovetilating patient aggressively, but aggressive airway interventions may not be warranted due to the patients decreased oxygen demands. And interventions like nasopharangeal airways and nasal intubation may precipitate lethal arrhythmias. Use the least aggressive for of airway management appropriate for the patients condition and respiratory status.

If you don’t think they have a pulse, check again really, really hard.

The American Heart Association is currently recommending that a professional resuer feel for a pulse on a hypothermic patient for 45 seconds. Personally, I’d feel for it for even longer. then I’d auscultate for it and then I’d feel for it again.

Once the patients skin is cold and the peripheral vasculature is constricted it may be phenomenally hard to feel a pulse. If the patient’s heart is still beating there’s a great chance that it’s circulating enough blood to accommodate the patients decreased metabolic demands, and far more effectively than your chest compressions.

Once we begin compressions we can almost guarantee that the beating heart will transition into v-fib and the possibility of a successful resuscitation becomes highly unlikely. Some guidelines even recommend forgoing CPR if you are within 3 hours of definitive care. If you need to do compressions, do them. But make darn sure you need to do them first.

Only defibrilate once.

That goes for AED shocks as well. If the first shock doesn’t work, neither will the second or the seventh. Try defibrillation one time and then put it aside and continue CPR until the patient can be warmed.

Skip the cardiac meds if the temperature is below 86 degrees.

Medication administration through peripheral IV’s is ineffective in significant hypothermia. Worse yet, we stand the risk of loading the patients peripheral vasculature with unmetabolized meds that won’t become available until the patient is warmed enough to begin utilizing their peripheral circulation.

If those vasoconstricted veins are loaded with cardiac medications, we increase the risk of cardiac arrest during rewarming. Some systems my allow for one round of cardiac meds, others may say stick to the basics until adequate rewarming can be achieved.

Use warm IV fluids when possible.

Many newer rigs out there have IV warmers in them. If that includes you, great. Infuse the warm stuff. If your rig doesn’t have a warmer, you may be able to warm a couple of bags by throwing them on the dashboard and cranking up the heater/defroster. be careful. we want warm fluid, not hot fluid. and you may want to warm up a could extra bags to tuck under the blankets with the patient.

Recognize the potential for renal failure and other warming complications.

There are many complications associate with the rewarming of serious hypothermic patients. They are dependent on the degree of hypothermia and the length of time the body remained cold.

Metabolic acids can build up in limbs and cause a generalized metabolic acidosis during rewarming. Muscles may break down in a process called rhabdomyoloysis and the circulating cellular byproducts put the patient at risk for renal complications including kidney failure.

Nobody is authorized to be dead until they are warm and dead.

Patients who attempt to die while hypothermic need to be advised that, in EMS, nobody has permission to be dead until they are adequately warmed. If a stern warning is insufficient, initiate CPR. And don’t stop unless they are warm and still insist on being dead.

As we saw in the last article, a few folks have been resuscitated from remarkably cold temperatures and incredible exposures. The body’s neuroprotective responses to hypothermia allow the body to go for long periods with little oxygen and the signs of severe hypothermia mimic death.

We can’t be certain that resuscitation is impossible until we’ve warmed the patient and allowed them a chance for conversion at normal body temperatures. Bring lots of rescuers; it may be a long drive.

So hopefully this gives you a solid overview of the general principals of hypothermia response. Treatment of hypothermia patients is a rapidly evolving field. Know your protocols and regional preferences for addressing this type of emergency. For more information, you won’t find anything better than the work of research physician Gordon Giesbrecht at The University of Manitoba. (He also happens to be a really nice dude.)

Now it’s your turn: Do my guidelines jive with your regional protocols? What types of things are you doing in your system to treat hypothermia? Leave a message before you go. I’d love to hear from you.

We all understand that hypothermia occurs when the patients core temperature drops secondary to exposure to cold. But, clinically, what is hypothermia really? What happens to the body as it cools down and struggles to maintain its core temperature? Can we predict a patient’s relative core temperature based on our physical findings? Is treatment really as simple as bringing them in and warming them up?

Let’s review the basics of the hypothermia progression and explore how to treat these sometimes challenging patient presentations. Put your mittens on, this is a chilly ride.

When we consider the typical hypothermia victim we often envision the lost hiker stumbling through the snowy woods looking for home. Perhaps our victim stumbles through a freezing stream, the sun begins to set and hypothermia sets in.

No doubt, our lost hiker is at risk for hypothermia, but we should consider that anything that decreases the body’s ability to produce heat or increases the body’s propensity to loose heat, can lead to eventual hypothermia. The prepared hiker may be less at risk for hypothermia than an urban soccer player who gets caught in an unexpected rain storm or an elderly nursing home patient left too long on an outdoor patio in the wind or an intoxicated transient patient who didn’t bundle up well enough before nightfall.

Hypothermia occurs more often in urban settings that rural settings and you’re just as likely to encounter it in Detroit, Michigan as you are in Missoula, Montana.

Recall that there are five ways for the body to lose heat:

Conduction: Touching cooler objects transfers body heat.

Convection: Air blowing across a warm body carries heat away.

Radiation: Heat radiates off the body into the air.

Evaporation: Sweat and moisture drying on te skin carries heat away from the body.

Respiration: Air gathers warmth in the respiratory tract and we exhale it.

Other factors both external and internal can speed the body’s willingness to sacrifice heat. Water conducts heat away from the body 25 times faster than air. Underlying medical conditions can also affect the body’s compensatory function. Any medical condition that hinders heart function, metabolic function, vasoconstriction or shivering will affect the patients ability to maintain core warmth. 

Being elderly, young, sick, drunk, male or high all make you more likely to succumb to hypothermia.

So now that we know how the body looses heat and what things might accelerate it, lets take a walk through a typical plummeting core temperature. The following numbers represent degrees Fahrenheit.

103.0-96.4 The normal core temperature range. Remember that body heat fluctuates quite a bit during a typical day. Exercise might raise core temperature from a standard 98.6 to temperatures as high as 103.0. Body temperature may also fall as low as 96.4 at rest. Temperatures in our limbs tend to stay 1-2 degrees lower than our core.

95.0 Mild hypothermia. Shivering begins.

93.2 Amnesia and minor errors in judgment begin. An individual may become overly emotional or easily irritated.

91.4 Major motor coordination begins to fade.

90.0 Moderate hypothermia. More significant changes in mentation including confusion and stupor.

87.8 Shivering stops. One this vital heat generation mechanism disappears core temperature will drop more rapidly.

86.0 Irregular heart rhythms emerge. Atrial fibrillation is the most common hypothermia arrhythmia.

85.2 Loss of consciousness more likely. Pupils Dilate.

82.4 Spontaneous ventricular fibrillation possible.

80. 6 Severe Hypothermia. Inability to move voluntarily.

78.8 Unresponsiveness to pain.

75.2 Significant hypotension sets in. Pulses become difficult to discern.

71.6 Ventricular fibrillation likely.

56.7 Coldest successful adult resuscitation.

57.6 Coldest pediatric resuscitation.

A good rule-of-thumb assessment for the hypothermia patient is to lay your hand on the patients abdomen. If he abdomen feels cool to the touch, generalized hypothermia is likely.

With your basic assessment and a rough idea of how the body devolves as hypothermia progresses, you can take a fairly accurate guess at the patients core temperature before you even hit the power button on the thermometer.

Looking at the progression of symptoms above, one of the real challenges of treating severe hypothermia becomes apparent. As the body metabolically shuts down in an effort to save itself, many of the symptoms of moderate and sever hypothermia mimic death and our aggressive interventions can easily do more harm that good.

We’ll talk moe about that next time.

Now it’s your turn: Have you treated hypothermia in the field? What were the symptoms like? What challenges did you encounter?

Want to learn more stuff?

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What Is Muscular Dystrophy Anyway?

What Is The Duty To Act?

What Is Epinephrine?

If you haven’t seen the first episode yet, you can find it right here. I strongly encourage you to take 20 minutes out of your day and watch it right now. This series and the individuals who surround it are worth watching not only for what they are doing, which is incredibly cool, but for what they represent.

The Chronicles of EMS isn’t just an extremely cool EMS documentary. It’s a milestone. It’s representative of a shift in the conversation about what EMS is, what it’s supposed to be and how we’re going to help it evolve. The conversation about the future of EMS is shifting away from the policy makers and mainstream EMS media and becoming guided by the individuals on the street who are doing the job each day. It’s an interesting and powerful shift.

Armed with the tools of the social media, like cameras, laptop computers, personal blogs and twitter streams, medics like Mark and Justin are exerting a huge influence over what we talk about when we talk about EMS. They are an example of how individuals who are willing to engage can become powerful levers for change. They both have very little organizational authority, but they are becoming a major influence within our industry by simply, respectfully, asking the question, “How can we make this better?”

I wasn’t able to be at the premier and show my support for this project in person. On the night when San Francisco became the geographic epicenter of EMS blogging, I was a mere 30 minutes away, at a nursing home, spending some precious time with my grandfather. There was no doubt in my mind that I was in the right place, yet my mind often wandered to the room full of people I’ve come to think of as friends and the important milestone that was taking place.

Fortunately, this event was well supported by the blogging community and you can get a great taste for the flavor of the event by visiting some of the sites of the bloggers who were there.

Mark Glencorse – Medic999

Justin Schorr – The Happy Medic

Chris Kaiser – Life Under the Lights

Gina Kaiser – @ginakaiser (Twitter Stream)

Greg Friese – Everyday EMS Tips

Natalie – MsParamedic’s Musings

Jared – My RT Life

Chris Montera – @Geekymedic (Twitter Stream)

 Jeremiah Bush – Jeramedic

Sam Bradley – Red Lights, Hot Spots and Disaster

Thaddeus Setla – @setla(Twitter Stream) <— (Pssttt, he’s the filmmaker)

If you’re interested in an inside look at what it was like to be there when the lights went down on the premier, these blogger’s and EMS personalities have the inside perspective.

What do you think?: How will Chronicles of EMS influence our jobs?

Not in a huge way. Not like if I had said something that you knew to be completely false, or got all wishy-washy, namby-pamby about some critical issue regarding your patient care. But it made you doubt my sincerity just a little. Somewhere in your subconscious you thought, “If it’s important, why not just say it?” You questioned why I felt the need to preface my important thought with a statement declaring my own thought important.

It’s as if I doubted my own credibility.

So why shouldn’t you doubt it too.

Right?

Truly important thoughts stand on their own credibility.

We do this to ourselves all the time. We don’t mean to, but we compromise the patients trust in our ability, our knowledge and our sincerity but making statements that serve no purpose. They are little red flags that we doubt our on sincerity.

Have you ever said any of these terminally redundant statements?

Trust us.

Don’t worry.

This is the honest truth.

Listen to me.

I’m going to tell you how it is.

I promise.

It’s OK.

Me too, it’s almost impossible to avoid. Best case, they waste time. Worst case, they undermine the patients trust in our ability or our credibility.

If the patient can trust you, there’s no need to say it. Just be trustworthy. If it really is OK, say why. If you’re going to tell people how it really is, just tell them. No need to request a listening ear, just look the patient in the eye and speak. If you have information that would decrease the patients worry, offer it, or be silent.

You can’t impart calm or trust or confidence or attention by requesting it. Those things are a matter of who you are and how you are and nothing else. I could give another example but I fear it would be redundant.

Now it’s your turn: Do you have a habitual redundant phrase that you just can’t live without?

More Awesomeness:

How to Set-Up an IV Line – Firefighter Style

What Is Ketosis Anyway?

Wrong Medicine

The Art of The Pulse Check

Six Techniques to Nail The IV Every Time