Life Under the Lights http://lifeunderthelights.com This blog is about EMS, and one Paramedic's quest to make this the profession it deserves to be. Tue, 16 Mar 2010 05:22:31 +0000 http://wordpress.org/?v=2.8.4 en hourly 1 lifeunderthelights/wvpBhttp://feedburner.google.com You HAVE to look at this… and The Handover Rapidly Approacheth http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/4zr1U90NnAs/ http://lifeunderthelights.com/2010/03/you-have-to-look-at-this-and-the-handover-rapidly-approacheth/#comments Tue, 16 Mar 2010 05:22:31 +0000 Ckemtp http://lifeunderthelights.com/?p=749

Peter Canning, the guy who writes the blog: “Street Watch – Notes of a Paramedic” has been just kicking blog butt lately with his series on prehospital medications. I read a lotta blog posts, but I’ve been thoroughly enjoying Peter’s stuff lately. I’d love for you to get on over there and enjoy it as much as I have been. I’m pleased as heck that he came to the www.FireEMSblogs.com network because I’ve been a huge fan of his writings for a long time.

Also, The Handover Blog Carnival (last seen over at Notes from Mosquito Hill) is being hosted right here on my little blog here. The theme is “Respect”. It will be posted on TUESDAY MARCH 30th and Submissions are to be accepted up until Sunday the 28th. Here’s a hint: GET YOUR SUBMISSIONS IN EARLY BECAUSE I HAVE ME A SURPRISE!! Yes, you really want to pay attention to this here Handover edition. So get it in early.


]]> http://lifeunderthelights.com/2010/03/you-have-to-look-at-this-and-the-handover-rapidly-approacheth/feed/ 5 http://lifeunderthelights.com/2010/03/you-have-to-look-at-this-and-the-handover-rapidly-approacheth/ Trust… It’s everything http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/nOzgbhwu6I8/ http://lifeunderthelights.com/2010/03/trust-its-everything/#comments Mon, 15 Mar 2010 05:29:05 +0000 Ckemtp http://lifeunderthelights.com/?p=746

Dooooo Doooooo! Beep Beep Beep Beep Beep Beep Beep  - Attention AMBULANCE ONE, Ambulance One. Respond Code 3. 1234 Anystreet lane, 1234 Anystreet lane for the (Insert Age and Gender Here) patient found unresponsive, unknown if breathing.

Imagine you heard that dispatch go out just now. Imagine you’re at home, off duty, and just happen to be listening to your dispatch channel. Perhaps you’re a volunteer, perhaps you have a scanner, but picture yourself hearing that and realizing… “Oh My God… That’s So-and-So’s house! A (blank) aged Male/Female? That’s gotta be So-And-So!!”

As an EMS person who lives in your district you know the people who work on the service. Now you’re sure you know the patient too. It’s someone you care deeply about and it sounds like they may be in mortal danger. As someone “in the know” you know what you’re going to do next, right? You’re going to listen intently to whatever traffic happens to come out next on the radio, aren’t you?

“Come on, Come on, Come on!” you think to yourself as you wait the agonizing seconds for the crew to acknowledge the page and go enroute to the scene. “What’s taking them so long!?” you ask yourself. “Ambulance 1 is enroute to 1234 Anystreet Lane” says the crew of Ambulance One over the radio. You don’t think that they sound excited enough. They must not know that this is So-and-So! To them, this is just a routine response for an unresponsive patient. They’re going to do a routine, every day job and perform their routine, every day care. They don’t have any idea that this patient is special to you and they’re going to give this patient the same care they’d give anyone else.

Now, since you’re sitting at home and unable to respond, you’re going to be glued to that radio, right? You’re going to know from the voice on the radio exactly who it is that will be taking care of “So-and-So”. You’re going to either be relieved or horrified by your knowledge of who’s on that responding ambulance. If you have trust in the medic on the truck, you’ll feel slightly better about So-and-So’s chances of survival. If you don’t have trust in the medics, you’ll probably feel a lot worse… right?

It’s always been a sticky ethical situation for a healthcare provider at any level to work on someone they know well and care deeply about. Try it just once, or more realistically for an EMS provider, have the situation thrust upon you, and you’ll see that “Stuff gets real” really quick. We have a vested interest in the care that our loved ones receive and while some of us may know that it isn’t always best that we personally be the one caring for them, we all understandably want them to receive the best care possible.

Trusting a provider to care for your special “So-and-So” is a big deal. I’m sure we all have secret mental lists of our colleagues whom we’d want caring for our loved ones and also our lists of who we wouldn’t. It is a supreme responsibility to be a healthcare provider in charge of the care of any patient and I believe that EMTs and Paramedics hold that responsibility every bit as much as or more so than any other healthcare provider. It is a responsibility that I don’t take lightly and one that I hope my colleagues do not either. We are the first people that our patients and their families want to see walk through their door when the unthinkable happens. When the situation is critical, and skilled, complex, time-sensitive care makes the difference between life and death, we are the ones out there doing just that. A good paramedic must be knowledgeable, highly skilled, and experienced to provide that level of care. Not just that, they must do it every time they get in their truck; because every patient is somebody’s “So-and-So”.

Speaking of “stuff getting real” I have to ask you: What kind of provider are you?

Are you out there every day earning the trust of your peers?

Do you work hard enough, study hard enough, and train hard enough?

Do you do your absolute best for every patient, every time?

When it does happen (and it will) that you are sent to care for a colleague’s “So-and-So”, are you the kind of provider they will trust?

If you think about these questions, you know the answers already. If you can honestly say that you’re good enough, I salute you. If not, well then we have some work to do, don’t we?

Earn it. Study hard. Know your stuff. Do your best. Every patient. Every time.


]]> http://lifeunderthelights.com/2010/03/trust-its-everything/feed/ 2 http://lifeunderthelights.com/2010/03/trust-its-everything/ Twitter Weekly Updates for 2010-03-14 http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/y8-QrTZcDc0/ http://lifeunderthelights.com/2010/03/twitter-weekly-updates-for-2010-03-14/#comments Sun, 14 Mar 2010 18:30:00 +0000 admin http://lifeunderthelights.com/2010/03/twitter-weekly-updates-for-2010-03-14/

Powered by Twitter Tools


]]> http://lifeunderthelights.com/2010/03/twitter-weekly-updates-for-2010-03-14/feed/ 0 http://lifeunderthelights.com/2010/03/twitter-weekly-updates-for-2010-03-14/ Any Random Person http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/-5qd3XMafk0/ http://lifeunderthelights.com/2010/03/any-random-person/#comments Thu, 11 Mar 2010 18:30:00 +0000 Ckemtp http://livingunderthelights9dev.wordpress.com/2009/02/27/any-random-person

I love Dave Barry, he has been called the most influential humor writer since Mark Twain. If you haven’t read any of his stuff, you really should. In fact, I’ll even provide a link to his web site here: www.davebarry.com. Yes, I’m providing that before what I’m sure will be my well-written, extremely interesting content below. He’s that good.

I put that up there because I am going to use a quote of his that he put into one of his columns; he asks his readers if they are saying to themselves “Hey, I can do this! *Any* random person can do this!” And he counters that they are wrong, because “It takes a very special kind of random person to do this”.

And that’s how I’m tying this into EMS.

I work with a few EMT-Intermediates (I-99 curriculum) and some EMT-IV Techs (WI has a version of a basic that can start IVs with NS and give a few IV meds) that are very sour on the fact that they aren’t paramedics yet. They’re not sour on the fact that they do not yet wish to sit through the required education to become paramedics, but they’re sour that there are skills that they can’t do that they see their ALS counterparts doing. They see us “paragods” performing ALS skills and say, “Hey, I can do that”.

And it may indeed be true. I see these days that they keep pushing skills that were once only the domain of paramedics down to the BLS providers. Heck, that’s what EMS is entirely built upon. In the far beginnings of our profession (and we’re still really in the beginning phases) the skills that Paramedics and EMTs perform were once only the domain of physicians. If you would have asked a physician in the 70’s whether a non-physician could interpret an EKG and give relevant medications and treatment as well as he could, you probably would have gotten a very incredulous answer. EMS is all about proving to the medical profession that treatments once firmly entrenched as only for use in the hospital have a demonstrated benefit to the patient when used quickly at the patient’s side close to the onset of symptoms. EMS personnel were trained for that most probably because it just isn’t cost effective to have doctors sitting around manning ambulances.

However, the question that has come up in my mind is where the bottom of that lowering of educational requirements for advanced skill performance ends. I have seen in my career a paradoxical movement in educational standards for paramedics and EMTs. There are a smattering of disparate and yet somehow complimentary certifications in some states, but while some educational standards have improved, most of them have decreased. While a good argument can be made for EMS levels between the Paramedic and the EMT-Basic, such as the I-99 and the IV tech in WI or the Iowa Intermediate in Iowa in the sense that they allow rural communities to be able to perform some advanced skills without having to shoulder the full breadth of costs and responsibilities associated with full paramedics, they also don’t take into account that a lot of those skills require a whole heck of education to be safely performed in the outlying patient that can be harmed by inexperienced providers.

The debate that I got into with an EMT-IV Tech over breakfast the other morning went something like this. He brought up the fact that EMT-IVTs could administer Narcan to reverse heroin OD’s or other narcotic overdoses. His statement to that was that they ought to be then able to give Morphine for pain control “since we already carry the reversing agent” (in case they give the patient too much or the patient has a reaction). My thoughts are that they should not be able to, because the administration of a narcotic for anything requires a requisite knowledge of the pharmacologic, physiological, and social actions of the drug. And while yes, that could be covered in a module I could assume, why should it be? I brought up that it takes physicians years of experience to be able to tell how to identify drug seekers who want to get a high from the legal, medically prescribed narcotic. Contemporary medical journals in family practice and emergency medicine have written volumes on the topic, and still physicians can be fooled. The extrapyramidal reactions possible with morphine, including respiratory and other Central-Nervous-System (CNS) depressing features of the drug have other treatments and symptoms that can be hard to recognize for an inexperienced provider. An EMT-IVT just doesn’t have the breadth of background knowledge needed in order to judiciously use the drug safely in all cases. The fact that most of the time it would work out fine does not withstand the certain percentage of patients that could and would be harmed. I ended the argument with him by bringing up something that I’ve always remembered from paramedic school. Our lead instructor told us that our drug bag was nothing but “A big bag full of poison” if you didn’t know how to use it.

Remember, every single time any medical care provider performs any treatment of any kind on a patient they’re making the statement that “Right now, I know better than your body does. I know better than your brain, your nervous system, and better than all of your body’s self healing systems do what you need to keep living and get better”. Any time you put on a bandage, you’re telling that patient that you know better than their body does that they need to stop bleeding. Every time a paramedic or other provider uses an airway management technique they’re saying that they know how to breathe better for the patient than the patient’s own body does. Every time you give a medication to a patient you’re telling them that you know how best to control their body’s systems. Think about it. Every treatment, every time. It is a HUGE deal to be able to do this stuff, and you dang well better know your stuff.

Physicians are rooted in the quest for knowledge. Their reputation as learned individuals goes back to prehistory in one form or another. They’ve earned their vaulted place in society due to their quest for knowledge and reason and their caring for others above all else. EMS people came from physicians. I can think of no other medical profession that has a downward pressure on their educational standards. I’m saying that, because I think that EMS does. We have elements in our own ranks, and external forces that are continuously working to make us into skills monkeys that can be paid very little and know very little.

This is a big statement: Not everyone can be a good paramedic or EMT. It takes a certain intellect, sound ethical reasoning skills, and a level of professionalism that not everyone can attain.

This is another big statement: There are groups in our society that want to make it so that any random idiot can become a basically qualified one. This keeps us all down and lowers the quality of patient care… a lot.

Yet another: Us good EMS people should be really ticked off that educational standards are so dang low these days. Fight for excellence. Respect ourselves.

If you and or your service want to be able to perform advanced skills, earn the requisite knowledge through your studies and earn the level that it takes to do them. Enough is enough. I don’t believe that we should lower any more educational standards. No other group would do this, not the nurses, not the PA’s, and certainly not the physicians. Why should we? Yes, I understand that with the advent of Urban Fire Based EMS the IAFF and IAFC want to put more paramedics on the streets to increase their influence and their revenues, and that in order to do this they need to match the intellectual skills of medics with the intellectual skills needed to be a good grunt firefighter, but EMS is a MEDICAL profession built from the quest for knowledge. It should not be relegated to the technical performance of skills if X equals Y.

Heck, I think that the current level of Paramedic should be the basic level, and that Paramedics should be as independent as Physician Assistants. In fact, I’d like to see that in the future.


]]> http://lifeunderthelights.com/2010/03/any-random-person/feed/ 12 http://lifeunderthelights.com/2010/03/any-random-person/ 3am with Ckemtp – (See Gus? I can do that too) http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/Dq9oRRaiJd4/ http://lifeunderthelights.com/2010/03/3am-with-ckemtp-see-gus-i-can-do-that-too/#comments Fri, 05 Mar 2010 06:33:25 +0000 Ckemtp http://lifeunderthelights.com/?p=737

(The title? My friend Gus writes the blog http://3amwithgus.blogspot.com – Occasionally I throw him a shoutout)

I don’t generally do this much anymore, but this is kind of a personal blog post.

It’s 19 degrees outside and the clock is nearing Midnight here in Illinois. About 20 minutes ago I was snuggled up with my beautiful wife in bed trying to get some sleep before I have to get up at 3am to drive to Milwaukee to catch a flight at 6am. Tomorrow brings something that I’ve been looking forward to for what seems like forever, but really has only been a month or two. Tomorrow I’m heading to Baltimore, MD to attend the JEMS conference, EMS Today 2010.

This is going to be my first big, national conference. Really, I’ve never had the incentive to go before. I’ve always wanted to, but they have always seemed to be too much of an expense and have always seemed far away from what I’ve been doing in the field. Tomorrow I get to see for myself just what the hubbub is about.

But that all seems pretty far away right now as I sit here in my fire station covering the ambulance. 25min ago (now) I was snuggled up all comfy like just in the twilight stage of my sleepy-time cycle when Mama Juggs, the night dispatcher tonight set off the vile tones a few times and sent all of the on-duty paramedics out to the various hospitals, leaving the district uncovered. She toned out for any available paramedic to come in to cover and…

Yes, the above was a horrible way to end a paragraph, (and Greg Friese recently told me I use the elipse (the “…”) too much) but I have to make this statement. Both my wife and I are firefighters and EMS people on the same volunteer/POP/POC/Takes-up-all-of-your-free-time department. We’re both dedicated as the next guy too, and she’s in paramedic school right now. So when the tones went out, I got “the elbow”. No, I didn’t go on the other calls but we had an ambulance crew at all 3 stations with an engine crew on-duty backing them up. There wasn’t a need for me to head in for the EMS calls, until they took all the medics off of the street handling them. They needed a medic to come in for the next call, and I have a Gina at home elbowing me in the ribs to head out into the 19 degree weather to go cover the district. Yes it’s now Midnight, and yes I have to be up at 3am to catch my flight.

I’ve spoken before about the responsibility I feel when I’m the only paramedic available to cover the emergency medical needs of a jurisdiction. Right now, there’s 30k people (roughly) whom for if they have an emergency medical need, I’m now the first person they want to see. If that happens (and now, one of the trucks is returning so the chances are lessening) I better be on my game when I get there.

Anyways, I’m sitting next to Mama Juggs (The Dispatcher, remember?) blogging away, and I should probably be a good conversationalist and talk to her because I haven’t gotten much of a chance to chat with her lately. So, in parting, if you are at EMS Today, come up and say Howdy! to me. If you’re not, be sure to follow me on Twitter and Facebook (the links are over there on the Right. I accept all friend requests that seem like fans.) and I’ll be sure to try and give you a first-hand look at what it’s like at a Big National Conference.

Oh, and the Biggest meetup of EMS and Fire Bloggers is happening Friday night at a pizzeria. BE THERE. If you need info, tweet me and I’ll getcha there. (Connections? I has them)

G’night all.


]]> http://lifeunderthelights.com/2010/03/3am-with-ckemtp-see-gus-i-can-do-that-too/feed/ 2 http://lifeunderthelights.com/2010/03/3am-with-ckemtp-see-gus-i-can-do-that-too/ Negativity, you won’t find that here. http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/OHA-jqvqZ1g/ http://lifeunderthelights.com/2010/03/negativity-you-wont-find-that-here/#comments Thu, 04 Mar 2010 19:25:43 +0000 Ckemtp http://lifeunderthelights.com/?p=734

A conversation that I had with a coworker this morning (Hi Kim!!) gave me the incentive to write this article. It brought up a question that I have to ask you:

Do you think that reading, listening to, or otherwise consuming online content is important for:

-          Your career?

-          Your Service?

-          Your Patients?

-          Our Profession?

And, why?

You could just stop reading here and throw in your own comment in the comments section, or you could read a few sentences into my own, rambling opinion.

I’m not just talking about my own, humble website here… I’m talking about the whole cacophony of online EMS content out there. You can see a lot of the stuff that I consume regularly in my blogroll, and can find a ton of other stuff through a simple Google search. You can follow the #EMS hashtag on Twitter, or you could do a Facebook search. Needless to say, there’s a lot of stuff out there for you to read and participate in.

But why is it important that you do so?

Because it is, that’s why. Trust me. I started my blog because I’m a ten year paramedic with a family to support and I have an obligation as a professional who cares deeply about my care for my patients and my wider community to change the profession for the better. I feel a deep-seated, compelling need to fix EMS and I’m not going to rest until I’ve changed the world. I am working the streets in my community every day taking care of the same patients that you do and I see the same problems you do… not only that, I feel them the same way you do. EMS is a big part of my life, and if you’re here reading this, it’s probably a big part of yours as well. There are plenty of people out there who you see and talk to all the time that will tell you that things can’t, or won’t change… but you won’t find talk like that here.

I think that participating in the wider online community of people who care about EMS is supremely important to the growth of our profession. When we communicate, we organize. When we’re organized, we’re powerful. One of the hallmarks of a profession as described in the literature is “Self Governance”, and we can’t self govern if we can’t communicate.

So, in a nutshell, Intelligent communication and discourse is essential to our progression forward. You’ll find that here (most of the time) and you’ll find a lot more of it out there. I can’t change this on my own. I need you. Yes, you personally to help us all by talking with your coworkers, bringing them into the discussion, and participating in the discussion of powerful ideas that are going to bring our profession out of the dark ages and into what we’ve been calling EMS 2.0.

What are your thoughts?

——————————————————-

Oh, and if you’re going to be at EMS Today in Baltimore this weekend, stop by and say “Howdy!”. I’ll be at the big EMS Blogger Meetup Friday night. I’d love to meet you. Need directions?? Tweet me @ckemtp.


]]> http://lifeunderthelights.com/2010/03/negativity-you-wont-find-that-here/feed/ 8 http://lifeunderthelights.com/2010/03/negativity-you-wont-find-that-here/ Guest Post – From JDmedic on Two Cases, One Letter http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/d9-9ZqhKxrU/ http://lifeunderthelights.com/2010/03/guest-post-from-jdmedic-on-two-cases-one-letter/#comments Wed, 03 Mar 2010 05:25:09 +0000 Ckemtp http://lifeunderthelights.com/2010/03/guest-post-from-jdmedic-on-two-cases-one-letter/

This is a guest post coming to you from a Mr. John Fekety (JdMedic) who took the time to leave a thoughtful comment on the recent post I wrote “Two Cases, One Letter… From One Paramedic’s Struggles, Change Can Come”. He doesn’t have a website for me to link to, but his resume is pretty impressive. I gave him the opportunity to flesh out the thoughts he wrote in the original comment, and I’m turning the post over to him. Good Stuff.

As promised, I’ll put a plug in for his friend’s Safety Training Business: Http://www.Source4Safety.com – Safety & Health Solutions, LLC

—————————————————————

Many good comments were made regarding the anonymous letter published here last week. Here are my two cents on the things raised in the letter by Ckemtp and others. First, I confess that I also routinely rant about other healthcare providers not understanding our profession, what we are capable of and what we required to do at times. However, the point of the matter is it is not in their job descriptions to educate themselves about us. We must become much more proactive in educating professionals and the public about whom and what we are. Granted, in a situation like described with the cancer patient with heated emotions, educating someone is not easy – if indeed possible. However, we need to begin to relate one-on-one during down times and talk about what we do and the things we come up against. Will it solve all of the problems? Obviously not, but it may crack open a door for dialogue in the future that can help defuse a tense situation.

Secondly, as both the letter writer and I have learned you have to pick your battles. Would it have done any good to bring up the MRSA issue with the sending hospital? Probably not. They could have simply said, “We told them.” Or more abrasively, “Are you questioning our professional ability to give a simple transfer report?” I think the suggestion of Dave Konig represents the best of both worlds. You let it slide with the sending facility and keep your relations there happy. However, you protect the patients in the other facility and maintain your professionalism by giving the receiving facility a heads up. Before the patient reaches the room you may say something like, “While I was checking the patient’s history during the transport I discovered a history of MRSA and I wanted to make sure you knew.” Everyone wins. Another part of this lesson is the patient does not leave your litter until you are comfortable with releasing the patient (more on this below), or you have no other choice.

Thirdly, we have to educate ourselves about the programs and people we deal with. In that regard, Dave makes a good point about hospice programs as well. Many hospice contracts require a patient to agree not to go to the ED in exchange for the hospice services, including in-patient care when appropriate. Under those circumstances, a patient who goes to the ED is dropped from the program and becomes responsible for all medical bills. Given the cost of just medications, conditions like this alone could drive a patient and family members over the edge. Whether that was the case with the patient in this instance is unknown. One service that I worked for had the director of a hospice service come out to a meeting and give us a presentation (did someone say education?). She explained the various services of hospice, why they may need a patient transported, and what we could do – within our scope of practice – to make things go as easy for the patient and family. It’s about communication folks.

Fourth, like others here I have been in the situation where I needed to be a patient advocate. I was doing an interfacility transport of a trauma patient who still rated pain at 9 out of 10 after meds. I asked the nurse about additional meds and she said the patient had already received everything he/she could recieve. I could have taken a chance, loaded the patient and called for pain management en route but I chose a more direct approach. I tracked down one of the ED docs and asked him to check on the patient with me since I did not feel comfortable accepting the patient in her current condition. (I learned that once the patient is on your litter nobody is willing to help since the person is now your “problem”.) When he saw the girl, he readily agreed she required more meds and not only ordered more immediately but gave me orders for addtional meds en route if needed. No arguments with the nurse, no bad feelings and the patient got what she needed. However, there are those times when feelings be damned and you have to take a stand for your patient.

An example of that situation was when I did an interfacility transport of a patient going for a cardiac cath and other procedures. The patient, in addition to having flunked his recent stress test, had a hisory of a previous MI. When we arrived at the receiving facility nobody knew where he was supposed to go because there was a question about which of two procedures were to be done first. We were finally sent to one location only to find it empty. We were redirected to another location to put the patient in a room until things were sorted out. We got to a hospital room with no monitor and an aid told us to put the patient in the bed. I asked about the monitor, she said there was none, and since he was not going to be there, long he did not need it. I explained that he came from a monitored bed, he required a monitor in the ambulance and he was not leaving my litter until he could be placed on a monitor. She huffed out of the room and came back with a nurse who restated that a monitor was not available and not needed. When I once again explained that the patient was not leaving my litter until a monitor was found. She left in a huff saying she was going to get a nursing supervisor to “… straighten you out.” I thanked her since getting a supervisor was better than us waging war. She came back without a supervisor, but with a monitor and told me the supervisor said I was to leave. With the patient in the bed and on the monitor, I thanked her for getting it and asked her to sign that she received the patient. Not unexpectedly, she refused. However, the patient’s wife who witnessed me ensuring that her husband received the proper care was more than willing to witness my note that the nurse refused to sign.

If we and the rest of the medical community (and/or the public safety community) want to use polite words, EMS is the redheaded stepchild.(Ckemtp here: “ouch”) In not so nice terms, we are the bastards. Either way, we are the new kids on the block and we still have to prove ourselves everyday. It has not been easy nor will it likely get any easier for quite a while, but there are ways we can stop shooting oursevles in the feet. When we hit the street if we keep the following in mind, maybe we can begin to level the playing field.

1. Look professional: If you wear a hat – one that is appropriate – wear it correctly, not to the side or backwards. How you chose to dress/look on your own time is your business. If your dress impacts me and my profession it becomes my business. Although I slack at polishing my boots, my uniforms are always clean and neat (at least at the start of the shift – stuff happens). Take a couple of seconds to tuck shirts in.

 2. Act professional: Everyone likes a joke. And, God knows many times with what we see we need humor to get through. However, remember what your parents said about a time and a place for everything. The parking area outside the ED is not the place to have a water fight with syringes. Nor is it appropriate to run up and bang on in-coming units.

3. Talk professionally: You do not need to be a walking dictionary or memorize Grey’s Anatomy. For the most part just dropping the slang and cursing would go a long way. “Thank you.” You’re welcome” Have a nice day.” would not hurt either. And out of respect for Thom Dick, let’s get rid of “No problem.” as a response to a thank you.

4. Respect your patients: If you call your patient, any one of the degrading words used in EMS to refer to, especially nursing home, patients (such as cheese or GOMER), go get a job for FedEx or UPS and deliver packages. You will make more money, not have to put up with mouthy nurses or winey patients. These are people we are supposed to be caring for. Many times, there may be nothing we can do except listen or hold a hand – and many times that is enough.

A final thought comes from a quote supposedly said by Mark Twain. “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.” Whenever it may be possible for you to be an example of an EMS professonal, act like one rather than acting as our detractors characterize us and provding their proof.

There are many things all of us can point to and complain about EMS and the systems, institutions and people we work with. I have worked in other professions and with all of the problems EMS has, I would not want to work anywhere else, as it sounds like so many other people feel.

————————————————————

Great Post, JDmedic. (Yes, this guy has more education than I ever want to sit through). He’s a lawyer-turned-paramedic and that just brings a smile to my face, I have to tell ya’.

Comments are, as always, very much welcome.

(Would YOU care to guest post? Shoot me an e-mail at ProEMS1@yahoo.com – Or Tweet me @ckemtp)


]]> http://lifeunderthelights.com/2010/03/guest-post-from-jdmedic-on-two-cases-one-letter/feed/ 4 http://lifeunderthelights.com/2010/03/guest-post-from-jdmedic-on-two-cases-one-letter/ Some Recent Blog Carnivals You Should Look At http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/b9JNX0KuHmA/ http://lifeunderthelights.com/2010/03/some-revent-blog-carnivals/#comments Tue, 02 Mar 2010 13:08:32 +0000 Ckemtp http://lifeunderthelights.com/?p=717

One of the best Blog Carnivals out there is The Grand Rounds Blog carnival. I had the honor of being included in it this go’ round. It has been adeptly hosted by Dr. Anonymous over at his blog – Http://www.DrAnonymous.com – Head on over for some of the best in blog-type medical content.

GrandRoundsLogo

Oh, and if you haven’t checked out this Month’s version of The Handover Blog Carnival, it was hosted by our buddy Mack505 over at his EMS blog, http://www.NotesFromMosquitoHill.com – Check it out. It’s the foremost EMS blog carnival out there.

The Handover Logo

http://notesfrommosquitohill.com/2010/02/the-handover-passion-edition.html

Head on over and read em’. Lotsa good stuff over there.


]]> http://lifeunderthelights.com/2010/03/some-revent-blog-carnivals/feed/ 0 http://lifeunderthelights.com/2010/03/some-revent-blog-carnivals/ The Shine Factor http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/x9h_dmEuOhg/ http://lifeunderthelights.com/2010/02/the-shine-factor/#comments Sun, 28 Feb 2010 14:41:00 +0000 Ckemtp http://livingunderthelights9dev.wordpress.com/2009/02/10/the-shine-factor

 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

—————————————————

You know what I’m talking about here. The distinctly subtle, but powerful mix of sights, smells, and sensory input you find when walking into the apparatus bay of your station. The faint smell of diesel exhaust mixing with rubber tires, the musty smell of damp hose drying on the rack, the smells of not-so-clean turnout gear (best right after a good fire), and all of the various cleaning products used to keep the trucks looking their best. My favorite is when I’m just walking in the station for start-of-shift. It’s about 6am and the guys before haven’t gotten up yet to turn on the lights in the bay or make noise. One of my favorite things to do is to walk around the bay with the lights off, with the sun just starting to glint in from the windows onto the dark floors. It’s quiet. I love the first sunlight making deep reflections off of the shiny paint and gleaming chrome. The trucks just seem to be anticipating the day, yearning for the next call to come in. The atmosphere is electric, and quite palpable. You could blindfold me and take me into any fire station in the country and I could identify it just by smell alone. It’s intoxicating. I think that I like it more than my fiance’s perfume. It’s ok, she’s a firefighter too. She gets it.

So, what I’m about to suggest here plays off of that knowledge that we’ve all got… It’s basically an EKG hooked right up to the morale of your organization. I call it the “Shine Factor”.

Fancy name, huh? Yea, I liked it too. I’d recommend that every person who works in any fire station or ambulance base walks into the apparatus bay every time they start their shift. Don’t go in through any other door. Walk right into the apparatus bay with the memory of the favorite time you’ve ever been there. Take a big whiff of the natural aroma and look to see how much your trucks shine. Check the corners for cobwebs too. Then, simply file the information away in your brain and know exactly how the morale of the troops is doing.

Why is this so simple, yet so powerful, and a lot of the time, so unnoticeable? It’s because every organization has grunts, and the grunts carry out the day-to-day operations of your organization. No matter how many policies are written, budgets are adhered to, or strategic plans are championed by administration, the grunts are out there actually performing the duties that make your organization do what it does. If your department is like every department in the country, the grunts have more tasks than just providing service to the public; they’re responsible for cleaning, maintenance, and upkeep of your equipment. The lower and more “gruntish” they are within the organization, the more responsible for the upkeep they are. This is where the Shine Factor comes into play. Every group has assigned or assumed maintenance and cleaning tasks. Administration can formalize it with all of the written plans, paperwork, and task sheets that they want to, but all those pieces of paper ever do is ensure that the tasks are done to the minimally acceptable level. They cannot and will not make the grunts put in the elbow grease required to get that extra shine out of the equipment. My theory is that only happiness and pride in the organization entice the grunts to go above and beyond, to put the extra few swipes with the rag onto the chrome to really bring the shine out. Think about it, when you complete a task and get it looking good enough to pass muster, you could stop… but if you really have the pride and desire to make the equipment look it’s best, you’re going to go get the magic cleaner in the storeroom and clean out the crust around the lug nuts to make it look perfect, to reflect the personal pride you have in the organization and your fellow grunts.

Do you think that the grunts will spend those extra few seconds, minutes (or in my case, hours.. but I’m obsessive) to make that floor it’s cleanest, or that chrome it’s shiniest if they’re ticked off about management’s latest asinine policy or off the cuff directive? I don’t. It’s human nature. It works on a subconscious level across all of the grunts you have who polish your stuff. If the morale of your department is in the tank, your stuff may be cleaned regularly because the grunts will be sanctioned if they don’t clean off the first layer of crud… but that’s usually where it stops. When morale goes down, the shine factor goes down. When morale goes up and people are uplifted, pride goes up and the grunts put forth the extra effort. It affects more than their performance at the station too, it affects how polite they are to the public, how clean and pressed their uniforms and presentation are reflecting your public image, it affects how much personal effort they put into training, and it may very well affect patient and emergency scene outcomes too. You can regulate all that you want, but the beatings never improve morale. The only things that can do that is respecting your grunts and treating them like adults.

I haven’t formally named it, but I think that new officers and/or managers in the EMS and Fire industry who were promoted from the troops arrive to their new posts with a predetermined agenda. I don’t think that they can help it. Usually, it’s from the mistakes they’ve seen their coworkers make on the streets around them and builds especially upon their own pet peeves. They arrive to their managerial desk wanting to “fix” things and usually the result is a lot of new policy objectives and memos. They know who, at least subconsciously, they want to get back at for the aggravation that they’ve caused them over the years and think that the rest of the organization will share their personal pet peeve. Unfortunately, these attempts to “fix” things usually do just the opposite. The new managers with their personal objectives take things to the extreme. They fail to respect that the people who committed the offenses against the manager’s pet peeves are concerned adults that may have very different pet peeves, and they fail to recognize that every single employee’s pet peeve is micromanagement.

To some managers, paper seems to solve everything. If your ambulance turn-around times are too long in your opinion, you create a paper system to fix it complete with a memo and/or a new policy. The crews fill it out, and it’s supposed to make the management and crews aware of the time it takes them and it’s supposed to fix the problem. Got dirty floors in the trucks? Make a “clean floor” policy with a tracking sheet. Got a crew who uses too much gauze? Make a “Gauze Utilization” flowchart with a tracking sheet. Does your station go through too much toilet paper? You see what I mean. While all management wants to create measurable objectives, all employees hate being micromanaged.

Shortly after I got my first management position my boss, the COO, related to me a story about what he did one day when he found a truck that had been left absolutely filthy by a crew after their shift. Apparently this crew hadn’t been running more than usual that day, and had just left the ambulance filthy. Now, what he could have done, being the COO and all, is write an edict to be handed down through the chain-of-command to have the crew reprimanded from on high about the clean truck policy and the proper utilization of cleaning materials. He could have written a memorandum, or even a shiny new “Clean Truck” policy to enforce the rules. There could have been reams of paper and managerial-type fire power brought down on these guys. But that’s not what he did.

When the crew who had left the truck that dirty came back in for their day shift the next morning the COO met them at the door and lead them to their ambulance. At their ambulance they found a whole host of cleaning supplies… and two chairs. The COO then proceeded to have the medics sit in the chairs while he cleaned their entire ambulance, inside and out, from top to bottom.

Unorthodox? Sure.. Effective? Yes. The problem had been attended to, the desire for a clean
truck was reinforced, and the crews saw just how badly the COO wanted the trucks to be cleaned. Now maybe that’s not something that would work at your department, but it sure seemed to at this ambulance service. Maybe your shine factor would be increased if the grunts got the chance to work with the brass on solving problems like this. Maybe myriad policies aren’t the answer, and teamwork and mutual respect are the answer. Maybe communication increases it. Maybe the full realization by everyone within the organization that everyone has their roles and everyone has to be given the tools to take responsibility for what they own increases it.

Until now, this piece has focused on management, but us grunts can benefit from increased shine factor as well. Right now, you need to decide that you’re going to put in the effort to increase the shine factor in your department. Remember, it’s a subconscious thing. Everyone just feels better when it looks like people are taking pride in the department. Everyone from your partner, the guys, the brass, the public… even you. If the grunts make the effort, it can benefit the shine factor too and maybe the other stuff will come along with it. Positive attitudes breed positive results. It sounds corny, but someone’s gotta make the decision to be the positive change in the organization. Even in a perfect situation, if there even is one, someone’s gotta keep making the decision to keep it that way. Let that be you and others will follow suit.

Now get out there and polish some chrome.

——————————————————————-

 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts


]]> http://lifeunderthelights.com/2010/02/the-shine-factor/feed/ 2 http://lifeunderthelights.com/2010/02/the-shine-factor/ Two Cases, One letter – From one Paramedic’s struggles, change can come http://feedproxy.google.com/~r/lifeunderthelights/wvpB/~3/QqDLqCMJMio/ http://lifeunderthelights.com/2010/02/two-cases-one-letter-from-one-paramedics-struggles-change-can-come/#comments Thu, 25 Feb 2010 23:48:23 +0000 Ckemtp http://lifeunderthelights.com/?p=712

A letter I received from a reader recently has gotten me just as mad as he is, even more so maybe. This letter came in from someone who identifies himself as a paramedic but asks that I protect his identity and location completely. I will do so, only identifying that the letter comes from someone who works out west, somewhere between the Mississippi and Montana but not east as Maine or as far south as Amarillo.

So He comes from somewhere in the US, not the east coast, and not Hawaii. He’s a paramedic and he’s male. That’s all I’ll say. I’m going to work the things he wrote me in his letter with my thoughts and feelings on what he wrote and the situation he wrote about. I’ll rewrite the letter keeping the point of it intact. I’m fairly sure that you’ll be just as angered as I. (Note – This is LONG but it’s good. It will probably tick you off too, enjoy)

It Begins:

So the other day, I made a decision. I was transferring a patient from a small ER to a larger hospital a short distance away for an inpatient admission from the emergency room. This patient happens to be one of our regulars, and I’ve come to know him pretty well in the course of taking care of him over the time that I’ve worked here. He’s legitimately sick, and certainly has been dealt a poor hand by life. His list of ailments would confound a gerontologist but prove terribly daunting for her team of doctors taking care of him as a young adult. He has been in and out of hospitals since his adolescence and through his contact with medical care has contracted MRSA, one of the scourges of the contemporary age.

Normally, taking care of this patient is a pleasure for me as he is always a good conversation and my familiarity with his conditions has given me a comfort level while in his presence. However, something troubled me with this trip.

This time the patient was being transferred to a room number that I recognized as being on the Mother/Baby unit at the receiving facility. I knew that their policies would never allow an adult colonized with MRSA to lie in the same bed normally occupied by mothers and babies in their most tender first moments. The risk of cross-contamination and infection is too great to allow such a thing and a newborn infected with MRSA may not fare well. Transferring him into that bed put mommies and babies at risk, and I recognized the danger.

Here’s the rub though, the nurses in the small ER had arranged the transfer with the nurses at the receiving facility. They were all hospital folk, and had more experience in the hospital than I do. They arranged it, and if I had voiced my objections I would have been perceived as a troublemaker and as the bad guy. I knew what I was doing was unsafe for every patient currently on the mother-baby unit of that hospital and could pose a risk to every baby born there in the future. Sure MRSA isn’t the end of the world, but why increase the risk to a newborn?

I think that we’ve all been there, and you’re right. MRSA isn’t the end of the world these days. Pretty much everybody has it, and it’s nearly impossible to eradicate from the healthcare environment. If you’ve read my stuff on limiting the spread of nosocomial, or “Healthcare Acquired Infections” (HCIs) you’ll know that I try to keep my personal paramedic practice clean and to limit my own risk of spreading the disease between my patients as much as possible. With that said, buddy, I’ve been there. I’ve been in the position many times where I saw something improper… something that could potentially hurt someone, and have known that if I were the one to speak up, I would be the one considered to be the agitator. I would be the “Uppity” paramedic causing problems… it’s a tough call.

The letter continues:

I ended up holding my tongue and not speaking up. I knew that I wouldn’t be viewed favorably if I had said anything and I didn’t want to create problems with the receiving facility. Honestly, I’ve spoken up on some bigger issues in the past and I decided to pick my battles on this one… I didn’t need them mad at me for yet another issue that they thought to be trivial and I wasn’t in the mood for trouble. I put the patient on my cot and gave him excellent interfacility care and a comfortable ride to the receiving hospital. Then, I wheeled him right up to the mother/baby unit and put him in his bed in the birthing suite. I didn’t like it… and the nurses who worked the unit seemed to be a little spooked by the complexity of the patient’s multiple conditions. I explained it to them in detail because of my long-time relationship as an acute caregiver to the patient. Then, when they seemed satisfied with the report, I left the room. My partner and I began heading down the hallway towards the elevator when we were met by the House Nursing Supervisor who stopped us and asked us “Did you know we can’t have him on this unit? He’s got MRSA! We can’t have him up here!”

I said “I’m really sorry about that, but this is where everybody told us to take him.”

She left to go into the room, presumably to arrange transfer of the patient to another unit that would pose less of a risk for cross-contaminating the most vulnerable of patient populations. I think that it was a good idea for her to do that. I still can’t believe that there was a breakdown in communications, forethought, or whatever on the part of all of those other professional medical people that would cause this inappropriate room assignment and an additional risk, albeit a small one, to mommies and babies.

Sure, it’s not the end of the world. I know that. However it was still inappropriate and should have been caught by someone. I’m just as guilty as everyone else because I didn’t speak up, or even ask anyone a simple question. (Insert Melodrama here) if just one baby gets infected with MRSA and has a poor outcome or even dies, am I partly responsible for that? (End Melodrama)

Well, I feel your pain. You probably aren’t a baby-killer just yet, although you’re right to think that there is a chance. Hospitals have infection control procedures for a reason and HAIs are the 4th leading cause of death in the United States. So it’s an issue. It could have been a simple oversight on the part of the small ER who didn’t work for the receiving facility, but the receiving facility should have known to follow their own polices. They could be less at fault here if the small ER didn’t inform them of the MRSA, which in turn is possible for them to have forgotten. There’s a lot of wrong here. Yes it’s a small issue… but what if the disease were, say, ebola or something. What if this were something that would immediately cause people a lot of harm? Chances are that someone would have caught it… but what again if that person were you, should you speak up?

This wasn’t the only case that the letter refers to and let me read this part of the letter to you as well. Let’s see if you can see how these two incidents tie in together:

This case got me thinking about another case where I spoke up on behalf of what I thought to be right and have been raked over the coals for doing so. I was dispatched to a private emergency call in another ambulance service’s jurisdiction to take a patient from his home to the med/surg unit of a hospital that we only occasionally transport to. It was a non-emergency request through a home healthcare agency and the patient had originally been transported back to his home via our service. In fact, we were talking with the crew who had taken her to her home originally when we got the call. They said that just a few days prior when they transported him, he was a remarkably pleasant patient and that they enjoyed taking care of him. They wanted us to say hello for them.

We drove the 25 or so minutes out to the patient’s house in an affluent part of the county and when we arrived on scene we were met by a male who identified himself as the patient’s son. He looked positively spooked and told us that the patient had been having a fit of rage for the last 24 hours or so. He said that he was paranoid, combative, and was convinced that his family was trying to kill him. He wished us luck and told us that this was going to be a tough one for us. Compounding all of this was the fact that the patient was up some steep multi-level stairs and down a tight hallway. We were going to have to use our stairchair to get her out. They also informed us a bit on the patient’s condition, which was basically intractable cancer and palliative care with a valid DNR order in place.

I’ve been in plenty of these situations before over the years, and my thought is that it is better for a patient to be mad at me if they are to be mad at anyone, lest they spend their last days on Earth mad at their loved ones. I’m a professional. I can take it. I informed the family members down in the foyer that I would play the role of the “bad guy” so that they could be the good guys in the situation and that I would be the one that the patient should be mad at, not them. They seemed to be relieved and agreed to this before we made patient contact. We climbed the stairs together and entered the room.

The patient was loud and was yelling at an obviously frazzled home healthcare provider who was trying to get him calmed down. As soon as he saw us walk into the room in our uniforms he said “Oh my God! You’re here! Take me to the hospital! These people are trying to kill me!” and began to cry. He was definitely paranoid and most definitely very agitated. I walked over to him, introduced myself, and told him that we were taking him to the hospital so they could take care of him. He immediately calmed down and tried to climb out of bed to go with us. He was still relatively healthy in the early stages of his hospice care and could almost get out of bed on his own. I asked him to wait a bit so I could take a look at him before he got up.

This is where the situation starts to go South. You see, I am a paramedic and not an ambulance driver. My job is to provide excellent healthcare to the best of my ability and scope of practice and not to just give a ride to the hospital. I assess every patient and treat them as they need me to. That’s what I did here. I found him to have tachypnea, a very low pulse-ox, and to be markedly tachycardic above 160. This was a sick man, and an unstable patient. My professional judgment was that this patient was wholly inappropriate for an unmonitored bed in a regular Med/Surg unit. Sure, the patient has a DNR, but DNR has never stood for “Do Not Treat” and this nice man needed immediate treatment to calm his symptoms and ease her suffering. My guess is that his agitation was being caused by his hypoxia and tachycardia, which was also being compounded by the fact that she was suffocating to death.

I let my partner know that I wanted to get the patient into the ambulance so I could correct his hypoxia and take a look at his EKG tracing. I opened up the stairchair to get it ready for him and handed our standard paperwork to the family for them to fill out the demographic information and sign the proper forms for us. Then my partner and I lifted the patient to the stairchair, wrapped him up in a blanket, strapped him in, and began wheeling her out of the room to the staircase. As we did so, I mentioned to the family that the hospital may wish to hold the patient in the emergency room for clearance before admitting him to the floor as his condition may warrant that.

That’s when everybody started yelling at me.

Nobody in that room wanted the patient to be taken to the ER. They were adamantly against it and were immediately mad at me for even suggesting that he might be taken there. They were pissed. A lot of statements berating me, my professionalism, my care, and even my integrity were thrown at me in a very short amount of time. As someone who understands the grieving process that a family experiences in a time like this, I understand when they need to lash out and as a professional I’ve already mentioned that “I can take it”. A lot of what I thought to be calm, compassionate, and professional talk peppered with a lot of “Sirs” and “Ma’ams” came out of me as I struggled to carry the patient through the narrow, twisty hallway. The patient sensed the discord that was taking place and got immediately mad at me for angering his family. I had said that I would be the bad guy, and now I was. They were all hopping mad at me.

My partner and I got the patient down the stairs and out of range of the family only to have the patient balk at letting us lift him to the cot. He imagined that the papers I had given to the family were some important and shady legal documents that he absolutely needed to have in his possession before we took him away in the ambulance. Finally, seeing no way that I could convince him otherwise, I went back up into the family room to get the papers while my partner waited downstairs. I was again met by the anger of the family. I honestly, truly tried to explain to them that the patient was unstable with something that we could maybe fix in the short term that would make him much more comfortable in his last days, that I understood that he didn’t want any heroic measures, and that I was at the mercy of my medical control physician who controlled such things. They were still angry at me but agreed to handle it at the hospital. Heck, even the home healthcare provider laid into me on this one… like it was my fault that he didn’t understand the difference between a stable and an unstable patient. Isn’t it his job to provide palliative care and to keep the patient as comfortable as possible? Isn’t it his job to know that treatable suffering should be avoided and to know that hypoxia causes agitation? Isn’t it his job to work with the entire spectrum of the healthcare team to provide the absolute best patient care in any circumstance?

Oh buddy, I’ve been there. I know that these situations are just plain hard for any provider to manage when you add in the dynamics of a hostile family taking out their justifiable grief on you, the healthcare provider; I’ve been there when people interpret “Do Not Resuscitate” orders as “Let the patient suffer and die quickly from treatable conditions” orders; and I’ve certainly been there when I’ve been considered an “Ambulance Monkey” who should just “Shut up and do what you’re told!!!!”. However, let’s continue with our colleague’s letter.

After I escaped the family and got back downstairs, my obviously frazzled partner had gotten the patient onto the cot with the aid of some of his friends that had stopped by and calmed him down. We buckled the safety belts and beat feet right out to the truck. I hopped in the back with the patient and my partner got up front to just leave the angry scene as quickly as we could. Luckily, the patient was amenable to letting me treat him and I placed him on oxygen via Nasal cannula, on an EKG which showed Sinus-Tachycardia, and he even allowed me to place an IV. He appeared to be dehydrated and I checked his blood sugar for a precaution just to be sure he wasn’t hypoglycemic. He calmed down markedly with the oxygen and the fluids. His vital signs came back into more normal ranges and while he still wasn’t out of the woods as far as his acute symptoms were concerned, he was a bit more comfortable and stable with the care.

For a few minutes, that is. He fixated back on the paperwork that I supposedly had given to his family and even though I gave him copies of the standard forms for him to peruse, he was convinced that I was doing something nefarious. He started to become agitated again and tried to rip his IV out. I stopped him and he grabbed my hands to restrain ME from stopping him. Owch. I figured that him holding my wrists was better than his ripping out his own IV and I let him continue. I was able to get my cell phone out and dialed up the receiving hospital to give a report. I thought that I painted a calm, cool, and detailed picture for them and suggested that I would stop in the ER for them to take a quick look at before going up to the floor, since at their small community hospital they bring every patient in right past the ER nurses’ station. As they answered me incredulously, the patient dug is fingernails into my wrists. I thought I maintained composure over the phone… but when I said”good luck” to them they must have gotten mad at me. They said that they would meet me upon my arrival, which took about another ten minutes for me to arrive there to do so.

After taking the patient out of the ambulance he was very much relieved to be back in the hospital. I explained the situation to the ER nurses and the ER physician, including the patient’s condition and the family dynamics involved. They assessed the patient and paged the admitting physician… who stated that he didn’t know that the patient was unstable and refused the admission to Med/Surg pending clearance in the ER. The ER staff wasn’t too happy about having an additional patient to attend to, and I could only imagine how mad the family was going to be.

So let me get this straight. The ER being mad about taking a patient who could have been a direct admit and would have been otherwise none of their concern is a familiar theme for me. While I don’t agree with it, I know how they can be sometimes and honestly I can see how their constant condition of being overworked and underappreciated can color their attitudes. I get that. What I don’t get is what the family and the “Home Healthcare” person had against the patient being cleared in the ER. You’re right that paramedics, EMTs, and EMS personnel are not simply “Rides to the hospital” and must use their professional judgment with every patient. You have to do an assessment, you have to provide an appropriate treatment, and you have to advocate on behalf of the patient… even when nobody wants you to. It’s your license and your career. Doing the best by every patient isn’t always easy… but it is always the right thing to do. However, don’t finish this letter because I can see where this is going.. don’t tell me what happened next.. Just don’t tell me that THIS happened.

A few days later I was called into my boss’s office. He was livid to say the least. Apparently I got a formal complaint from the family, from the hospital, and from the home healthcare organization. I was the bad guy here everyone thought, and because of it we had lost the transport contract with the home healthcare organization, lost the contract with the hospital, and ticked off the family big time. My name was mud and my butt was in a sling. Apparently I was rude, I had acted against the wishes of the family, and I had interfered with the orders of two separate physicians. They accused me of “Not thinking about the company” and told me that if they had to lay off staff because of the drop in call volume that it would be my fault when they got laid off. They mentioned firing me… but what saved me was my impeccable record, the fact that my partner who happened to be a supervisor of a lower certification level had filed a commendation in my file for the way that I handled it… and the fact that as far as patient care was concerned… I was right. It was clearly acting in the best interest of patient care and the recording of my radio report that they played for me showed that I was trying to be polite… except for the “good luck” part… they were mad at that. I explained to them about the fingernails and the fact that I had been extremely polite to everyone concerned in the trying circumstances. I ended up not having any negative sanctioning… but they were still mad… and the former contracts still aren’t calling. I may have irreparably damaged my service by doing what I thought was the right thing to do.

Man… that just sucks. It seems to me that you were caught up in a situation where you couldn’t win. Yes, you did the right thing by the patient and if everything you say is true, I commend you on your patient advocacy… but your boss is right, if the contracts don’t call and send their business elsewhere, it hurts the company’s bottom line. That’s a reality in for-profit, not-for-profit, and in all ambulance services that depend on transport revenue. I would say that if the relationship you had with the contracts was that tenuous to begin with that you aren’t the root cause… but perhaps the situation was the last straw. I would ask what the home healthcare person was doing while you were taking the brunt of her inaction to correct the patient’s immediate suffering or to communicate to the physician the seriousness of the patient’s condition… but my guess is that she was of the opinion that the patient was “Just a DNR”.

And this is the part of the letter that really gets me:

The part of these situations that really gets me? The time that I stood up for the best patient care I got raked over the coals… the time I potentially killed babies? Nothing.

There is so much at play here that transcends the experiences of the person that wrote the letter that I don’t know how to address it without turning what has become a very long article into a chapter of a book. The way I see it, this is a breakdown on so many levels. However what slaps me in the face is the fact that apparently nobody in those situations respected your professional judgment. You were seen exactly as you put it, as little more than an “ambulance monkey” who they thought was supposed to do exactly as you were told. While the first case was a mild example, you did what you were told to do and the hospital caught the mistake after possibly no damage had been done. While you could have voiced objections, you’re very much right that you would have been seen as the troublemaker and would have been told to mind your own business. I can’t even imagine that you would have been vindicated when the nursing supervisor caught the error… although that may be because your letter has left me with an aura of generalized cynicism. Sure, the potential existed to cross contaminate a neonatal unit with MRSA due to a medical error; you knew about it and did nothing due to internal politics. That’s bad… but understandable because I’ve been there.

The second case is worse. What do people expect when they call an ambulance? Do they expect you to just throw the patient on the cot and take them to the hospital as they told you to without giving an assessment, using professional judgment, or doing anything the way you’re supposed to? What about when you stood up, and you were punished for being an “uppity” paramedic?

I’m so mad I can’t see straight. I gotta take a break in writing this….

What we need as a profession is to be out there earning our professional respect. Obviously nobody you were dealing with had any respect for EMS and you and your service have paid the price for it because apparently they hold all the cards.

What this harkens me back to is the representations of the “Ambulance drivers” I’ve seen on every TV show or movie I’ve ever seen. They’re portrayed as bumbling idiots who run real fast, take orders from the shows main characters eagerly, and then scream off into the night doing exactly what they’re told to by whomever they just met that seems to be in charge. Look at how the paramedics are portrayed in ER as intense, harried people that are just waiting to tell the doctors “I can’t do that, I’m just a bambilance driver” and can’t seem to treat even the simplest of conditions. I’m actually pretty sure that is what some medics do in order to avoid confrontation, they do exactly what they’re told and figure that the consequences are someone else’s problem. In fact, that may work out well for them as they never make waves and never get into trouble that way.

I tell my students that I’ve been doing this for more than ten years, and in this job when you’ve been doing it for as long as I have, working around a bunch of type “A” personalities whose jobs depend upon them being “right” the first time every time, that if a person hasn’t ticked some people off they must be doing it wrong. I believe it. Anyone who advocates tirelessly for the best interest of their patients is going to tick some people off sometimes… It offends the most tired and or laziest among us when they are involuntarily compelled to do the right thing sometimes less they end up looking foolish.

I don’t have an answer for you, anonymous paramedic… just keep doing right by every patient. And be sure to BE NICE. That’s all I got. Well, that and push for professionalism and education. Push public education and perhaps set up a meeting with the people involved. Continue being the most professional and caring paramedic you can be.  You may not fix it fast, but collectively we all can make a difference.

We have to.


]]> http://lifeunderthelights.com/2010/02/two-cases-one-letter-from-one-paramedics-struggles-change-can-come/feed/ 15 http://lifeunderthelights.com/2010/02/two-cases-one-letter-from-one-paramedics-struggles-change-can-come/