Emergency!

January 15, 1972 may be the most important day in the history of EMS when it comes to public relations.  On that day, the first episode of Emergency! aired.  Telling the story of firefighter/paramedics John Gage and Roy Desoto, the show dealt with their day to day challenges which, while they had a touch of “Hollywood drama” in them, were stunningly realistic. The show depicted the pair responding to everything from routine and sometimes comical medical calls to huge fires and disasters.  You got to see them working with the doctors and nurses at Rampart General Hospital and the other firefighters at Station 51.  I first saw the show in 1999, and I honestly cannot think of any television show prior to that or since that more accurately showed the lives of paramedics. Emergency! ran for 7 seasons with 131 episodes aired.  That may seem like a lot of material to come up with to some, but those of us who work in the field know that if nothing else, EMS gives us an almost limitless pool for stories sad, touching, funny and exciting alike to share. Happy 40th birthday, Emergency!  You were able to accomplish something that no one has been able to do...

Appendix V!

Friday afternoon while I was checking my email I that I had a new e-mail from the Commonwealth of Massachusetts’ Office of Emergency Medical Services.  Every year around this time they like to send out any pending protocol changes that are being released with the annual March 1st updates.  Version 10.01, due go into effect on March 1, 2012 has a great new edition that I am very excited about. On the summary sheet of expected changes, protocol 1.6 for Post Resuscitative Care had the following addition: Mandating therapeutic hypothermia do not delay transport.  hyperlinked to Appendix V. While the state might need some work on their punctuation and capitalization, I was excited to see that Therapeutic Hypothermia was being added to our scope of practice.  I moved down to Appendix V to see what was in store for me in the coming year.  The new protocol describes the implementation, necessity and reasoning for the use of prehospital hypothermia in the following way: Cardiac arrest patients of medical etiology, who have responded to ACLS resuscitation efforts of any rhythm and demonstrate restored cardiac output and hemodynamic stability, but subsequently display signs of severe ischemic brain injury or coma, are candidates for instituting therapeutic hypothermia. Statistics show a significant number of those who survive out of hospital sudden cardiac arrest suffer from residual ischemic brain injury following cardiopulmonary resuscitation. The return of spontaneous circulation (ROSC), while resulting in the reperfusion of vital organs and the re-oxygenation of tissue, is thought to trigger destructive chemical reactions within brain cells limiting neurological recovery. The process of instituting early external and internal cooling efforts and maintaining mild hypothermia (32-34° C) in the first 12- 24 hours has been demonstrated to be a beneficial treatment adjunct in protecting the neurological function of cardiac arrest victims and improving patient outcomes.  Therapeutic induced hypothermia has been shown to be of significant benefit to select patients; continuation in-hospital is essential to its benefit, and may be a factor in hospital destination decisions by medical control. They get it.  All of the work done by services such as Wake County EMS, MedStar in Fort Worth, Texas and countless others is finally making a...

100% Absolutely Wrong – Your Comments

Last Monday, I posted my views on the story that came out of Prince George County, Maryland involving a child who was transported in the back of a fire truck who was in cardiac arrest.  My opinion about the incident ruffled some feathers but it also sparked some terrific discussion not only on my blog, but it also helped fuel the topic at EMS12Lead, and on Facebook as well. I stand behind my statement that I felt the decision made was reckless and absolutely wrong.  While human emotion drives us, sometimes we need to fall back on our training.  When we walk into a scene, we are there to bring order to chaos, not add to the craziness. I have never had as many comments on a blog post as I did on this one, and while I replied to a few of them within the post itself, I thought I would take the time to share some of them here. Tom Bouthilette from EMS 12 Lead wrote: “It’s easy to second-guess the boots on the ground but unless you’re the one there watching a child die you can’t know what it was like.  There is no “absolute.” While I agree with Tom that there is no absolute, I do not think any of us would sit back and idly watch a child die.  We have training, and we would let that training guide us in caring for this individual with the equipment we had on hand.  Also, isn’t learning from mistakes made and dealing with the tough situations to improve care what we are here for?  Isn’t that why we write, and retrospectively look at situations that have happened in the past, whether they are positive or negative? Matthias Duschl asked: “Why do you see a need for punishing this crew?  I totally believe that we create better medics by analyzing what they do, measuring the outcome, and if something isn’t optimal, we should improve it by training not by suspending people who did something that saved a life but wasn’t according to their protocol.” Without protocol, we are nothing more than cowboys running around the streets shooting from the hips.  Policy and...

What’s On Your Belt?

Over the years I have seen a variety of EMTs who carry a variety of equipment on their person.  I have seen everything from window punches to elaborate holsters with a round of soft goods to virtually nothing at all.  It made me think about my own personal compliment of supplies that I feel are vital to my job that I carry on my person every day. The amount of stuff that I carry on my full-time job in the city varies a bit from my old part-time job when I worked at an amusement park, and when creating your own supply list I suggest you keep that in mind as well.  Tailor it not only to what you need to have right by your side but also what will be close. 1.  Radio – I always have a means to talk to someone not only via phone, which in a pinch will take too long, but also by radio.  Also, how is anyone supposed to get a hold of me if they cannot get me on the air? 2.  Scissors – The trauma shears I carry at work (in my pocket, not in my belt) have a set of Rip Shears attached to them as well.  This way, I can get through anything I might have to on a scene with little difficulty. 3.  Two spare pairs of gloves – Usually, my first pair of gloves sits in one of my front pockets until I decide to put them on.  My second pair is in one of the leg pockets of my uniform pants, usually on the left side.  Why the left side?  Because that is where I have always put them.  I try to carry the same stuff every day in the same place.  It has become a routine of sorts for me. 4.  Handy wipes – In my other leg pocket, I usually carry eight or ten of our industrial strength individually packaged handy wipes.  They are not just for my crew and I but also for the police or fire department should they need them.  These things are really popular with our first responders, and I swear along with coffee,...

On Resolutions – Control

Lately, I have been very emotionally charged at work.  Well, really, that’s a nice way of putting it that I have not seemed happy which has been noticed by many people.  I tend to wear my emotions on my sleeve and frustration is certainly one of those that I do not hide well.  During a “venting” session at shift change a few weeks ago one of my colleagues said to me “maybe you need to reevaluate how you are sharing your message.”  I appreciated those words, and really went beyond that.  I decided to reevaluate my entire approach to how I do some things. It should not be any surprise that I am a control freak, a Type A personality.  That is something from my street paramedic career that I was not able to shake, and it rears its ugly head in my middle management style sometimes.  I am always watching what goes on around me, and often have an opinion about what is taking place.  I tent to express that opinion whether people want to hear it or not.  The first internal struggle that I need to address is I need to come to terms with the fact that I cannot control everything.  My focus needs to be narrowed and more concise during the course of my day.  Putting my energy towards changes that can be made and be productive as a result will make a difference in how I spend my time, and the outcomes that I see from it. I also need to come to terms with the fact that some things will never change, like some people’s beliefs.  People are who they are and I need to integrate myself into the system instead of demanding that the system integrates itself to me.  I need to trust that like me, other people are doing what they feel is in our best interest, and I need to move away from a “my way or the highway” attitude that I sometimes slip into. Finally, I cannot hang my hat on an expectation of praise; you cannot expect that to come whenever YOU want it to.  EMS is a thankless profession, and much like...

100% Absolutely Wrong

Recently, an article was posted about a group of Prince George County, MD firefighters who violated policy and transported a child in cardiac arrest to the hospital in their fire engine with what was described as “limited medical supplies” instead of waiting for an ambulance that was less than five minutes away.  The child, who was reportedly having an asthma attack, arrested in front of the crew.  The paramedic who was on scene made the decision to start transporting in their fire truck after getting what can only be assumed was an unacceptable ETA of five minutes.  According to the Prince George County Fire Department, the patient regained pulses prior to arrival at the emergency room. The firefighters who were involved were not suspended without pay.  Their medical control was not pulled.  They do not even appear to have been reprimanded by their department.  Instead, they have been given valor awards for their life saving actions that day. First, I do not want to overlook the miracle that took place on this call.  A life was saved albeit using very unconventional and potentially dangerous actions.  Effective CPR was done, and the girl lived, without any residual neurological deficits.  I give them credit for their care, but only to that extent.  This does not mean, however, that these firefighters should not stand and explain their actions. As I stated previously, the fire truck that was used on the call had limited medical equipment, and according to the press release, it was not one that was typically used for medical calls.  This leads me to believe that the life-saving actions taken by the paramedic that day was effective CPR which could have been done just as well, if not better, on the patient’s living room floor until a transport capable unit arrived. What about the large amount of departmental liability this crew put their employer under?  The girl had no neurological deficits but if she came out of this with so much as a limp or maybe slurred speech, her family could have owned the entire department, and potentially taken that paramedic for everything he had because of what would have only been described as “gross...