Feb 25, 2015

Friday afternoon I got a text from a friend of mine pointing me towards a debate that had broken out on an EMS related Facebook page about the perception of tattoos and their impact on professionalism.  A lot of this has been spurred along by the beautiful artwork that Holly Monteleone displays on her arm in A&E’s new show Nightwatch.  Tattoos say nothing about a paramedic’s ability to care for a patient.  Thinking otherwise is a debate that I will not even entertain.  The perception that some int he general public might have when they see your tats though is another thing all together.   While I do not have any tattoos nor do I plan on even getting one, a number of my friends have them.  The vast majority of them are pretty cool to look at.  There is a story behind each and every one of them and to that specific person, their selected piece of body art means a lot to them and I respect that.  On the flip side of that coin though, we are often asked to define what professionalism is, and really for the most part it varies greatly depending on the community one serves.  What might be accepted by some might be shunned by others.  This rings true for body art. One of my favorite tattoos stories involves a good friend and coworker of mine who I was on a run with for an elderly female with COPD.  Sitting by her door, and throughout her apartment she had a number of Buddha statues.  We started our patient on her nebulizer treatment and my partner said “Nice statues!  I have a Buddha tattoo on my belly!”  My sly, slick COPD patient looked at him and said “I don’t believe you.”  Not one for backing down from a challenge, my partner pulled his shirt up displaying his full belly tattoo with his belly button matching up with Buddha’s and said “Look!”  The three of us shared a good laugh, and it was a constant topic of conversation for the remainder of the call. I understand tattoos as a form of expression.  As a former supervisor I can also see...

Feb 18, 2015

With the five year anniversary of the blog next week I wanted to share a couple of posts about me outside of EMS. I started reading through some older posts and my bio and realized that while I have spoken a lot about my career I have not talked much about how I got here. As I have mentioned I grew up in Island Heights, New Jersey.  While MTV might have given the Jersey Shore a bad rap it is in fact a great place to be a kid. Island Heights was not the busy tourist attraction that Seaside, located just a few miles away, is but it is a small sleepy shore town.  If I walked out our front door all that I had to do was look to the left and right to see everything that I needed growing up. To the left was a small park complete with a field, basketball court and woods suitable for hours of manhunt. To the right was the Toms River and the 18 foot Boston Whaler that I spent day after day on during the summer. If you’ve met me in person you know I’m a tall guy.  Six foot five to be exact but I’ve taken to telling people that I am five nine and a half just to see their reaction.  Although I was a three sport athlete until I reached high school (basketball baseball and soccer) because of my height I was under the most pressure to play basketball which coincidentally was my least favorite out of the three.  I first set foot on an ambulance as a cadet in my freshman year of high school and fell in love with it instantly. While I played sports and spent time at practice and games I looked more forward to going home turning the pager on and waiting for the next call to come in. We were not a busy department but we did okay considering our size. EMS was what I loved more than anything so much so that I took my EMT class at night while I was a sophomore in high school. By my junior year I had decided that...

Feb 13, 2015

For the last forty years Hollywood and EMS dramas have not mixed.  When it comes to creating a drama that relatively, not even accurately, portrays the daily lives of EMTs and paramedics, many of us in the field have viewed attempt after attempt with high hopes only to walk away disappointed.  Trauma.  Rescue 77.  Even Third Watch.  None of these shows have even remotely captured what my life is like on the truck or off. Reality TV has not done much better.  Paramedics on TLC back in the 2000’s came close however the show was so poorly edited that I don’t think that they had anybody with an EMT card in their back pocket in the cutting room with the power to say “this doesn’t look right.” While I was excited for its premier, I am sure you can understand my reservations when A&E announced their new series Nightwatch which was set to follow the EMS, police, and fire personnel working the 8pm-4am shift in New Orleans, Louisiana.  My interest was piqued after seeing the trailers though.  I was excited to see that Dick Wolf, creator of  Law & Order had a hand in it, and I was even more excited that it was following one of my favorite reality TV shows ever to be on television: The First 48. The EMS/fire ratio One of the first things that struck me about the show was how the cast was introduced in the premier’s first fifteen or twenty minutes.  Two medic units care for a shooting victim as he circles the drain.  The police officers portrayed in the show search for a shooting suspect.  Then we cut to the fire house where the guys of Squirt 27 are debating what they are going to have for dinner.  I chuckled because that’s how it usually goes in urban EMS.  EMS spends their time in mobile offices with fire department units landing back in a station. Please do not take that as a dig at the fire service.  I have a ton of respect for the men and women who do a job that I have zero desire to do, however, as the show progresses through the...

Feb 3, 2015

Throughout the years, I have received a lot of advice from a lot of people.  I thought now would be a good time to share some of those quotes with you so that you might have the chance to learn from them as well. “If they’re bloody, clean them up.” – John Glowacki I’ve written about Big John before.  He was one of my first EMT instructors and had a major influence on my career, and how I practice medicine even today.  I was on a crash with him that was relatively minor, but the patient that were caring for was fixated on all of the blood covering her hands.  His point was a simple one.  Cleaning her up a bit not only would give you a better idea of where the blood is coming from, but it would also make the patient feel a little better not having to stare at what belonged on the inside that was now on the outside. Put the clipboard down.  Don’t worry about your tablet.  Leave the laptop closed.  Don’t touch any of that stuff until your patient is completely taken care of, and trying to clean them up a bit is part of that. “Rule number 1: People die. Rule number 2: Paramedics can’t do anything to change rule number 1.” – Bob Moore This is something else that I have talked about in the past.  As you may remember, Bob was one of my paramedic instructors and this was part of the speech that he gave us on the first night of class.  A few years ago, I wrote about accepting mortality and quoted Bob.  He commented on the post and shared the origin of it: In the fall of 1983, I was a NU medic student and not to brag but I did very well in class. Near the end of class we had an instructor named Joe Duecy run one of our last mega codes before exams. He put me through each and every rhythm known to man and I hung in there with the correct treatment and got the patient back with a pulse. After 30 minutes of playing with me Joe...

Jan 25, 2015

About two weeks ago, Dr. Aaron Carroll published an article in the New York Times entitled “Doing More for patients Often Does No Good.”  This weekend, the article received a significant push on social media, specifically, Facebook, on a number of EMS related pages.  I know Dr. Carroll’s writings, and I have listened to him frequently on Stand Up! with Pete Dominick where he is a frequent guest and occasional guest host.  While Dr. Carroll has a number of citations and makes some valid points, I think that the portion of his story about out of hospital cardiac arrest misses the mark.  Here’s why. A number of the studies that Dr. Carroll cites were released between 2007 and 2011.  We are learning, and we are evolving.  Systems throughout the United States have changed their protocols and changed how cardiac arrests are run.  My state’s protocols have been rewritten to include the actual words “High performance Pit Crew style CPR” in the BLS cardiac arrest portion.  They’re getting it, and they are seeing an improvement.  Still though, tossing aside ALS care is a short sighted argument to make, even in cardiac arrest. While I will not dispute that solid BLS care is the foundation and the largest contributor to out of hospital ROSC, we need to look beyond achieving a return of pulses in our prehospital care.  ALS interventions after the return of pulses make a significant difference in patient outcome.  12-lead EKG interpretation, for example, can help determine destination decision for a patient who arrested due to a STEMI.  And let’s not overlook the importance of therapeutic hypothermia, something put on the map in the United States by Wake County EMS in the mid 2000’s. The point is, resuscitation does not stop once ROSC is achieved.  We don’t stand up, high five each other and say “okay, that’s it.  Let’s drive them to the hospital.”  There is more work to do. This statement in particular got my blood boiling a bit: “Some theorize that the things that work have already been incorporated into basic life support.  All that the advanced life support may be doing is slowing things down in the field, distracting people from the useful...

Jan 16, 2015

What makes somebody qualified to teach an EMT or paramedic class?  I took my first EMT class back in 1995 at night while I went to high school during the day.  I knew every single one of my instructors either personally, or more likely by reputation.  They were sage-like legends in the field of EMS.  They were the old guard.  And it was their job to educate the young, motivated naive students such as myself. Fast forward to college and it was much of the same.  For the most part, the people who taught my second EMT class and my paramedic class already had twenty to thirty years in the field.  They lived and breathed EMS and would share story after story about what they encountered over the years.  They talked about the first time that they had to tie an ankle hitch because the one provided with the HARE had been lost under the bench seat, and that was why it was so important for me to learn how to do the same. In May of this year, I will celebrate my fifteenth anniversary of getting a paycheck for working on the ambulance but my life in EMS extends a couple of years past that.  I got my start in the back end of what was the successful days of volunteer EMS.  We covered our calls, did not understand what a ROSC rate was, and were happy to get a CPR save pin every year at our department’s installation dinner.  Daytime ambulances were staffed by mothers who put their kids on the school bus and then turned the pager on, people who worked nights, or some of those legendary EMS providers who taught at night and were otherwise retired.  They donated their time which is something that does not happen very often anymore for a number of reasons some of them cultural, and others financial.  Any way you cut it though, volunteerism in EMS is all but done in most of the country. So here we sit now, half way through this decade, and we need to figure out who takes the reins.  Many of those EMS legends are in the twilight of...

Jan 7, 2015

A couple of years ago I read a great article by Kelly Grayson on EMS 1 that talked about patient refusals and more specifically a person’s ability to refuse.  I liked it so much that I adapted parts of it into a refresher lecture that I did for a couple of years up in Massachusetts.  Now, almost five years later when I am back on the street, I still use portions of it as part of my refusal assessment. Kelly talked about orientation, memory, cognitive ability, and recall as ways to expand upon the old adage of “alert and oriented to person, place, time and events.”  On every patient that is going to refuse my care, and often on almost every patient that I do any sort of orientation assessment on there is one simple problem solving question that I ask them: “If I gave you two quarters and a dime, how much money would you have?”  The answer, of course, is sixty cents.  Easy, right?  I’ve run into patients though who were able to tell me who they were, where they were, and when it was, but were not able to answer that question. It also gives me another leg to stand on if someone misidentifies “time” for whatever reason.  I’ve found through the years that time is the one that is most often missed.  How many times have you asked a patient, “can you tell me what day it is?” and had them giving you a correct answer that had you looking at your partner for confirmation because you are not completely sure what day it is?  I’m a forgetful person, and it happens to me quite often. Take, for instance, a retired patient, or a patient in a nursing home.  Days might blend together for them and while they might be able to correctly identify the year, or tell you what holiday we just had or are going to have, correctly identifying the day of the week, date, or month might not be as easy as one might think.  Of course, you might ask a patient for a recent holiday, and have them answer “Christmas” and then ask them the month and...

Dec 24, 2014

Although I have a love for politics, I usually do not share many of my political views on this blog unless they directly relate to the industry.  This matter, however, is close enough to share some comments on.  Four years ago, I would have never even thought to write this post because it would have been too close to home, but looking at things from a distance can shed a different light on certain situations and offer new opportunities to comment. Earlier in the month, Holyoke, Massachusetts City Councilor At Large Rebecca Lisi along with one of her city council colleagues was a participant in a “From Ferguson to NYC to Holyoke” protest march in downtown Holyoke.  The stated mission of the protest was “to protest the recent shootings of unarmed black men, women, and youth, and support the call for reforming problematic police practices.”  According to Lisi’s blog her reason for marching was to show her 14 month old son that “human beings have the ability to affect extraordinary changes.”   The march drew criticism due to the crowd chanting, among other things, the title of an 80’s rap song that many see as being derogatory towards police.  I’m sure you know what I am talking about.  I am not the only one who finds her mere participation in such a protest a problem.  The Holyoke Police Union expressed their displeasure with Lisi and her colleague Jossie Valentin. Lisi denies taking part in the chant and said that it “stopped quickly.”  She goes on, however, to praise the Holyoke police department about their continued commitment to community policing, which presents a sizeable contradiction.  She protested police actions and how they relate to her city and then goes on to say that her city’s police department takes the approach that they should take.  She is either very confused or was just protesting for the sake of protesting. Lisi is in a family populated by two generations of New York police Department officers, and says that she has “. .  . a deep appreciation for the hard work and risks that police officers take on every day in the field.”  Why, then, was she a no show...