Sep 10, 2014

For today’s post I was going to share my thoughts about the ongoing fight between American Medical Response and the Las Vegas Fire Department.  Some might say that with the Las Vegas City Council’s approval of the 5 year contract between the two, the “fight” was resolved.  Then, I read the editorial by Glenn Cook that I am going to share below.  There are certainly some alarming constraints that any ambulance provider opting into this deal will have to deal with, including what some may consider a gag order when it comes to speaking with the media. What could Las Vegas Fire and their chief William McDonald be so afraid of that would make them add this stipulation to the contract?  Ultimately, AMR did what they had to in order to keep their doors open for their 450 employees and their company.  I still feel that this move is more about generating income for the city and the fire department.  I have plenty more that I could say about this but I will defer today’s post to Glenn Cook and his editorial titled “City to AMR: Shut up and drive.” This is what defeat looks like.   This is what happens when a business, trampled by government yet still dependent on government approval to operate, dares to defend itself and alert the taxpaying public to obvious wrongs. This is what happens when city functionaries decide to expand their empire, regardless of cost, regardless of harm.   Wednesday’s Las Vegas City Council meeting was all about a proposed downtown soccer stadium. But amid the sports circus, the council presided over another significant action, one that officially killed the city’s dual-response medical transport system.   Private ambulance business American Medical Response fought the Fire Department, and the Fire Department won.   Earlier this year, Fire Chief Willie McDonald put his boot on the neck of AMR, which had been paying Las Vegas nearly $400,000 per year to handle most patient transports within city limits. He ordered his paramedic units to drive more patients to hospitals, so that the city could boost its bleeding general fund with transport fees. McDonald also cut off AMR from emergency communications and put...

Sep 9, 2014

We took the week off last weeks or Labor Day and this week the podcast is back with a short interview that I did on Jamie Davis’ The Medicast where we talk about the show and what it is all about.  Regular shows will be back next week!  Enjoy! To download the show in MP3 format, follow this link!  Otherwise check the show out below:  ...

Sep 5, 2014

My post today has nothing to do with EMS.  We all need a day off every once in a while, and last week I took mine.  With a trio of World War II planes coming to a nearby airport, my dad and I decided to go flying on the last airborne B-24 in the world.  Thanks to a friend at work, I was able to get my hands on a GoPro camera.  The people from the Wings of Freedom Tour were incredibly accommodating and allowed me to mount the camera to the belly of the plane.  It was a beautiful, clear, sunny day.  An absolute perfect day for flying, and I was able to capture the entire thing with the GoPro. Fast forward to about the 10 minute mark if you don’t feel like watching us taxi around . . . The second video all takes place in the air.  The view is great . . . Finally, we circle around a bit and eventually come in for a landing. . . Pretty neat, huh?  The best part of the day though is what happened after we landed. I was able to watch the takeoff and landing from my iPhone with the two gentlemen that I was sitting next to on the plane.  They were both World War II buffs and were very interested in getting their hands on the video so we exchanged email addresses.  While exchanging emails with one of them once I got the videos up, we discovered that we were cousins by marriage.  Who would have thought?  My dad and I take a day away, go for a fly, and end up meeting a relative that we did not even know that we had!  Crazy. Many of us in EMS are wired to work, work, and work some more until we drop.  We are slaves to the “big clock.”  But that does not mean that we don’t need a day off here and there.  Be sure to set aside time away from the “bus” for a day or two.  You never know what kind of trouble you might get in.    ...

Sep 4, 2014

Social media has done a lot of good for society.  I have reconnected with long lost friends.  Because of it, I am writing on this blog today, and I have a way to advertise while I write.  Also, everyone can participate in the conversation with their own soapbox to stand on, and they can share their opinion to anyone who will listen.  On the downside, everyone can participate in the conversation with their own soapbox to stand on, and they can share their opinion to anyone who will listen.  In the weeks since the tragic events in Ferguson Missouri, I have made a frequent statement on Twitter and Facebook that can be summed up as “everyone is an expert in public safety.”  What I am talking about is the “should have” mentality that many have adopted. Take, for instance, that now infamous moment in time outside of Detroit, Michigan where two paramedics were photographed allegedly posing and smiling.  A friend of patient Jake Glover told the reporter that “you should be tending to someone who obviously needs your help, instead of worrying about taking a picture.”  From that moment in time with her limited knowledge of procedure and patient care, she made that conclusion.  Based on a picture.  A snapshot of a moment in time. Or how about an example that is much closer to home.  There is something that happens on almost every call that I have ever done involving a 12-lead EKG.  I like to call it “the stare.”  The leads go on, someone pushes the “12-Lead” button, and everything stops.  All of the providers on scene turn their attention towards the monitor and sit very still as they wait for it to start spitting out its treasure.  Once that print starts, all motion around the patient seems to start back up with it.  A number of years ago, I was caring for an unresponsive patient in a dimly lit apartment in a not-so-nice part of the city.  The leads went on, and the 12-lead started doing its thing when a friend of the patient walked in the room and saw what he thought was a couple of paramedics just staring at...

Sep 2, 2014

Last night, one of the major EMS news outlets (I cannot find which one this morning) posted a question on Facebook asking “What effect will raising minimum wage have on EMS?”  Since we are days away from a planned strike of fast food workers, I felt like this was as good a time as any to take a look at the topic.  While part of me hopes that some news outlet other than The Onion will post the headline “Fast Food Workers Strike, Americans Forced to Eat Healthy” my opinions on this topic are not quite so tongue in cheek. If you follow me on Twitter, or are friends with me on Facebook you will learn pretty quickly that I am not a fan of our President and more specifically his policies.  I think the affordable care act has been a painful rollout and the promises made to appease those who opposed it, “if you like your plan you can keep your plan” specifically have been violated and scapegoated on the system itself rather than those who have set the now stringent regulations associated with the act.  Now, there is a considerable push from many to raise minimum wage as high as $15, a wage that many EMTs in the field currently do not make.  If this happens, the response by many EMS departments and companies might be surprising to some. Raising minimum wage is effectively a “war” on big business.  People want a bigger slice of the pie that currently goes to the upper echelon of companies or their stakeholders and shareholders.  This same structure exists in EMS but in many ways, we are handcuffed when it comes to how much money that we can make by the very people who are talking about raising the money that companies are expected to pay their workers.  Ambulance reimbursement is a constant hot button topic at lobbying events and with EMS advocacy groups and in leadership forums.  We, as an industry, are just getting by.  If you want proof of that, look no further than Rural Metro ambulance after they declared bankruptcy in 2013 and are now getting ready to shut down their failing Indiana division. Or,...

Aug 29, 2014

As technology evolves so does the user.  The problem, however, is after a while, the user tends to become reliant on the technology.  For example, I remember when I was handed my first pulse oximeter.  It was a great new toy that I added to my BLS bag.  Boy, I thought, what did I do before I had this neat little machine?  The answer was simple though, I looked at my patient, assessed their capillary refill, and their work of breathing.  As my career has progressed, I have become less and less dependent on pulse oximetry and more dependent on my assessment.  But this post is not about pulse oximeters, it is about automatic blood pressure cuffs. Have you ever walked in to an emergency room bay with an agitated, hypoxic patient and turned them over to the ER staff, and seen them slap on an automatic cuff only to get a reading of 160/120?  What do they do then?  Document it and move on with their treatment.  Is that BP true?  Probably not, since your ears got 140/90 the whole way to the hospital.  The fact is, many ERs that I have been in have become reliant on their auto cuffs, and EMS is following in suit. LP-15’s, the Zoll X-Series, the new Phillips monitors, they all come equipped with auto cuffs and personally, I have never found one that I liked.  In a 15 minute transport time, especially when I am giving medications, I would much rather take a blood pressure with my own ears than rely on a machine that in my experience, more times than not gives me an inaccurate reading. Some people have developed a system for using their auto cuffs.  If the BP is close to the one they got manually, they’ll go with it.  But what happens when you are bouncing down the highway with a chest pain patient giving nitroglycerine to a chest pain patient?  Are they still hemodynamically stable or did that second sublingual bottom their pressure out? You might think you have the full story, but that auto cuff could be lying to you. The reasons for an inaccurate reading on an auto cuff...

Aug 26, 2014

As if the debates about arming EMS personnel and merging fire and EMS weren’t enough, I decided to take a stab at sharing my thoughts on another controversial one this week.  Of all of the skills and medications that a paramedic possesses in their toolbox, there is none that they are more protective of than intubation.  There is an almost constant debate not only in the EMS community but the medical community as well as to whether or not paramedics are good enough at intubation to be proficient at the skill, and do they use it enough to make it worthwhile for them to keep it?  Last week, Sean Eddy had a great take on this over at Medic Madness, and I thought that I would add my two cents to the discussion. As our field has evolved, we are intubating people less and less every year.  I like to say that intubation has gone from a life saving procedure to a life sustaining one.  More times than not, on the rare occasions where I intubate non-cardiac arrest patients I find myself doing so to protect their existing airway rather than to improve their oxygenation.  CPAP has changed the archaic treatment of CHF patients particularly that used to result in paramedics high fiving each other in the parking lot of the ER as their field intubated patients struggled to ween themselves off of ICU ventilators.  We used to think that nitroglycerin, morphine, and lasix with some PRN orders for versed was the way to go.  It’s not!  Who knew? There have been studies done over the last fifteen years, many of them recommending the cessation of field intubations after having retrospectively looked at success rates particularly among those incidents where a patient was turned over to the ER with an esophageal intubation, or as one resident in my current system likes to refer to it, they “stuck the tube in the goose.”  While I realize that studies like these take time to complete, maybe they are looking at the wrong things. A better take on the intubation debate would be to look at not only overall success rates but how quickly missed intubations are recognized, and...

Aug 25, 2014

What does it take to put a podcast together?  What are some of the important pieces of equipment that you need?  How do you upload a podcast and get it out to the masses?  This week, Scott takes a step away from EMS topics to give you a behind the scenes “listen” into what goes into the production of EMS in the New Decade! Blue Yeti Microphone Call Recorder for Skype Audacity free audio editor and recorder Libsyn Podcast Hosting Services To download the podcast follow this link. Or, use the player...