Apr 30, 2014

Yes, you read that title right: The Podcast.  The time has come for me to finally do what I have wanted to do for a couple years now.  On Monday May 5, I will release the first episode of my podcast carrying the same title as this blog.  This is something that I have wanted to do for a long, long time, and have been asked to do by a few people but I never really felt that I had the time. A lot of the roadblocks that I had keeping me from doing this are not there anymore, and it is time for me to take the plunge.  Monday’s show will be an overview of what to expect from the episodes to come.  Shows will be posted weekly on Monday mornings at 10:30am EST, and will be listed along with my other blog posts on the homepage of my blog.  In addition to that, there will be a link in the menu to take you to the index of all of my podcast episodes.  Also, I am currently creating an index of past episodes of other shows that I have been part of.  They will be part of this menu page as well. It feels really good to be back writing at 100%.  The major life change, and employer change took its toll on me for a while.  It is not easy to start over in a new system with new people, new protocols, and new everything.  I was ripped from my comfort zone, and it took me a while to get back close to it.  I’m not there yet, and there’s challenges that I am dealing with every day, but to be back writing is an important part of that for me.  It just seems like the next logical step for me is to get back into podcasting, and even more logical to finally host my own show. I really cannot tell you how excited I am about this.  Thanks to the support of people like Ben Neal, RJ Stine, Random Ward, Natalie Quebodeaux, and of course Kyle David Bates, Chris Montera and Jamie Davis, I am finally going to make it...

Right now, I feel like a minor internet celebrity.  I’ve been Rogue Medic’d.  That’s right, Tim Noonan, the Rogue Medic, has read one of my posts and posted a reply to it as one of his entries in his blog.  It all started last week when I shared my post as a comment to something he put up in regards to working a CPR with a LUCAS device and the relation of using epinephrine in cardiac arrests. The entry that I referenced was one that I posted a few months back about organ donation and how while not every ROSC will walk out of a hospital, we might produce the opportunity for organ donation for that patient.  While one life could be lost, others could be saved. Tim makes some excellent points in his reply to my comment.  Obviously, the job of every paramedic and EMT out there when working a cardiac arrest is to save our patient.  We want them to walk out of the hospital.  We want that chance down the road to meet them.  If that is even going to happen, we first need to achieve ROSC. My advocacy for epinephrine revolves around personal feelings based on my experience, I believe that the use of epi in cardiac arrests produces a higher ROSC rate.  More specifically, I feel that the effects of epinephrine produces ROSC in patients that we would not have gotten ROSC in.  I am mainly talking about those asystole patients and patients in an unexplained PEA.  Due to the fact that these people that are saved might not have been brought back otherwise, their long term outlook is poor. This differs from those patients that we encounter in v-fib and v-tach without pulses.  Those patients, again, in my opinion, should not get epinephrine.  The focus there should be solely on high quality CPR.  This part of my opinion is actually supported by studies. It was easy enough for me to find one from 2013 that states that while more trials are needed, detrimental effects post-cardiac arrest were greatest in patients who received epi and were in v-fib or v-tach.  So on that side, I fully support Tim’s repeated...

In all my years in EMS and my almost 14 as a paramedic I have seen a lot of creative solutions to the problems that we face on a daily basis.  Some have worked and stuck for years.  Others?  Not so much.  There are two all too common issues that I seem to encounter on a week by week (or even shift by shift) basis that have some very logical products on the market that I feel present an excellent solution to an otherwise challenging issue.  Also, I feel the need to mention that neither of these companies solicited me to write reviews of their product.  These reviews are based on my own personal experience. The EP+R Hand-E Hand Hold Device – One of the biggest challenges of any cardiac arrest or even an unresponsive patient that we are required to move on a backboard present is the conundrum of how to keep their arms secured so that responders can assess them and provide treatment.  Some use tape, other try to tuck their hands into their pockets or waist band, or even use a creative tie with a cravat.  The best solution that I have found though is EP+R’s Hand-E device. Back in 2006, one of the paramedics that I worked with in Massachusetts decided to solicit a few companies for demo versions of their hand restraint devices.  There were straps that needed to be wrapped a certain way, and a few solid devices that aimed at keeping a patient’s arms “in” to prevent them from snagging on door jams or ambulance cabinets.  We tried a handful of them and none was as easy to use and effective as the Hand-E.  It’s quite simple to use: after attaching the device to a waist strap of a backboard you put a patient’s wrist in each of the openings and secure it with the rubber strap.  A patient’s  arms remain reasonably flexed to allow the flow of IV fluids to continue while their elbows are kept close enough to the body that moving patients through doorways or taking them out of an ambulance becomes remarkably easier. According to EP+R’s website, the Hand-E retails for around $22....

Friday’s post about the now deleted craigslist letter got me thinking about the need for an in depth set of policies and procedures to help in decision making for everyone involved in an organization.  My boss used to like to say that there were so many grey areas in EMS that writing a set of policies and procedures would be exhausting and quickly rendered invalid.  I could not disagree more. I went from a service that had very loose procedural structure to being handed a three inch D-Ring binder filled with my new department’s P&P’s that outlined everything from the procedure to call out from work to how to properly place the pins on my uniform.  It was clear and concise and I loved it. Despite what they might tell you I feel that EMS providers crave structure.  If you want proof of that look no further than standing orders and protocols.  While a single protocol might not fit the mold for every patient and you might find yourself crossing from protocol to protocol.  You might not start at step one and move to step twenty hitting steps two through nineteen along the way but you at least have a framework to work within.  Policies and procedures need to be viewed with a similar mindset. No situation is perfect, and no solution is going to be 100% correct 100% of the time, but I feel like if a policy gives you the answer 50-75% of the time then it is serving its purpose.  A prime example would be something like “ambulance crews are expected to be available in the hospital within twenty minutes of their arrival.”  Is that 100% achievable?  Of course not.  There are so many outside factors like patient condition, decontamination needs and ER backups that might prevent this but it sets an expectation and a parameter for crews that if their patient is turned over they should be available in that time frame. Failure to set expectations for people leads to freelancing and frustration.  Rules are enforced from supervisor to supervisor and dispatcher to dispatcher with little consistency.  I know that this happens because I was guilty of it.  There were...

Late night I was shown a very public reply posted to a very private email circulated by management in a New England ambulance service expressing displeasure with the performance of many of their employees that some have interpreted led to the loss of a 911 contract that they have been given a second chance at.  Although the original email was never posted, the reply made on a craigslist page and signed by an “anonymous employee” called out management for their practices.  I read it, and I cringed. The post itself was flagged for removal within the first eight hours of it being posted online which is fine, because I would not have linked it here as I personally felt it was in poor taste.  While there is a time and place for sharing with the outside what goes on in the inner workings of an organization this was a lot of dirty laundry to hang on the line for everyone to see.  Quite often they are posted too quickly with the thought that “if I let the public know what is going on here things are sure to get better!”  In actuality, all this does is increase the gap between the field and management. As someone who has, in the past, pulled the pin on a grenade and tossed it into the fray, I can testify that actions like this do not help as much as many think that they will.  As my career progressed, I found it easier to write the email or memo and let it sit on the computer for a good couple of hours.  Then, I would come back and take a second look.  More often than not, my opinion would have evolved to an “it’s the same old complaint, it won’t help anyway.  I’ll keep it in my back pocket though.”  The draft would then be saved, and the window closed, as some fights are just not worth it. The anonymous writer of this post clearly was upset, and I doubt that his or her intentions were completely malicious, they should realize that the damage they did might be irreparable.  While it might be fun for some people to...

For the first twelve years of my career the answer to most questions was “just take them to the hospital.”  Don’t know what’s wrong with them?  Take them to the hospital. Paramedics and EMTs seemingly start to “over think” calls?  Stop thinking and take them to the hospital. A certain facility doesn’t want our medics to do anything for the patients?  Just get them in the truck and take them to the hospital. More times than not “take them to the hospital” is at least a functional answer.  Whether they need to be there or not a trip to the ER either delivers the patient to definitive care or makes them someone else’s problem.  Oh, and did I mention that taking them to the hospital allows a department to bill for the call as well?  It does.  Or at least it did in my former service, but that is another discussion all together. The big question though is what do we do when taking them to the hospital does not benefit our patients?  Who am I talking about?  Our cardiac arrest patients of course. By now many of the readers have seen Tom Bouthillet’s picture of the “Resuscitation Fairy” who magically revives our patients when we deliver them to the ER.   While Tom and I don’t always see eye to eye on issues in our industry, I feel like we are not only on the same page, but the same paragraph when it comes to running cardiac arrests.  I have been lucky enough to spend enough time with Tom that I have learned a great deal from him.  Changing how we do things can be scary.  It takes a commitment to do it.  We all have our comfort zones and stepping outside of that can be difficult, but we need to for our patient’s sake. Moving patients kills them, or rather prevents us from saving them.  Wake County has studied it and proven it.  The simplest thought processes confirm it.  A heart needs to beat in order to sustain life.  In order to get that heart beating again, we must work for it, whether that be manually or with a CPR assistance device...

Back in September of 2010 when this blog was still in its infant stages and living on Blogspot, I wrote a post about STAR CARE, which I described as the “magnetic north of your moral compass.”  In light of the recent events in Washington, DC (say it with me folks: WHICH ONE?!) I want to take a look at the decision made by Lieutenant Kellene Davis that led to her granted retirement and dodging of department discipline. For those of you who have spent the last couple of months living under a rock, or just recently have been introduced to the wonderful world of the internet, Lieutenant Davis was the officer in charge of Truck 15.  To summarize, and keep the story short, she failed to act when 77 year old Cecil Mills had collapsed across the street from her fire station.  He eventually died.  While we cannot be sure that a response by Truck 15 would have saved the man, what we can be sure of there was no action taken. Now, Dave Konig was quick to point out to me that STAR CARE is an EMS tool and not a fire department tool, but DCFEMS is an EMS provider, so STAR CARE can and should apply to them as well.  As the commanding officer on Truck 15 that day, the responsibility ultimately rests on her shoulders, or at least that is what DCFEMS wants us to believe, so looking at her actions seems to me like the appropriate thing to do.  Let’s take a look at this and see how Lieutenant Davis did. S: SAFETY This was an unknown medical, so looking at it from the most positive side of things, she did not send her crew into danger or allow them to cross a busy street. T: TEAM BASED By preventing her crew from acting, she did not allow them to serve the purpose that the crew was deployed to do which is protect the people and property of Washington, DC. A: ATTENTATIVE TO HUMAN NEEDS I doubt that Lieutenant Davis would want a medical emergency experienced by herself or a member of her family with the same disregard that she...

Over the course of the last year I have developed an established morning ritual.  One piece of that is sitting down and reading a series of links for the day that include local and national news sources as well as posts from selected blogs.  It helps pass the time in the morning, and it is something to do while I enjoy my coffee. Last month, I read a very moving post by Chris Kaiser over at Life Under the Lights about provider suicide.  That particular morning I was teaching at my department’s monthly educational day for one of our platoons, and one of the topics that I was tackling was stress management.  The post made such an impression with me that I included it in my lecture while describing the “code of silence” and how it applies to EMS professionals. It was a blunt reminder of the stress that each of us in this field deal with both as a provider and as a person.  We are not only expected to shoulder our own problems but we are expected to tackle the problems that everyone else around us has as well.  The result is us burying and burying and burying until our own feelings are so suppressed that when they do surface they are so overwhelming that they are that much harder to deal with. Sad to say, I am seeing more and more cases of provider suicide in the field.  It is a problem that is not going away.  In fact, my whole reason for writing this post is because I recently learned of the passing of someone that I met a number of years ago.  He was a hard-nosed paramedic who was never afraid to speak his mind.  Although he was one of those people who could clearly be a thorn in your side it was obvious to me that he had his peers’ and his patients’ best interest in mind.  Much like my other experiences with provider suicide, the news that I heard came out of the blue and based on what I have heard from friends, while there were some warning signs out there no one ever thought that he...

While I only fit one of the above listed categories, a friend and colleague in the department I work for now shared with his Facebook friends a great piece he wrote on being both a paramedic and a father.  Seeing as how he has been at this for around twenty years, and has four little ones at home, i bow to his expertise on both.  So for today’s post, I bow to the wisdom of Paramedic Corporal Lee Morris: “I’ve come to realize that being a father and a paramedic is quite alike. Both titles involve a steady stream of people trying to excrete things on me and my attempts to dodge the mess. Both titles often require I solve problems others have caused for themselves. Both involve my efforts to keep others from playing in traffic or fixing the boo-boos associated with similar activity. Both involve long overnight hours, busy weekends and holidays, occasional soul-crushing fatigue, and little time to rest before my charges are out to play again. Both titles require I respond at rapid pace to the siren call of someone in dire need, and at times they really only think they are in dire need. Sometimes in both jobs I have to medicate people or stick things in people that don’t want to be stuck. Occasionally they both involve me holding someone down who is inconsolable, kicking and screaming and completely unresponsive to reason. Sometimes in both I have to attend to people creating a scene in a public place, help them while remaining calm, and try to keep them from disturbing the general public. In both titles I am expected to be professional, positive, helpful, and have a never-ending source of energy and solutions. Sadly, I occasionally miss the mark when performing in both jobs and have to humbly ask forgiveness and move on. For one title I am paid, the other I am not, and there are days during which I would gladly trade that fact between the jobs. (Neither title pays enough, by the way.) Both involve the occasional sense of extreme accomplishment as I look back at my efforts to see the difference I have made...

With the general public clamoring for help, the debate over Narcan and who should have it rages on.  Recently, I read a post by EMS and fire author and blogger Captain Michael Morse from Rescuing Providence.  Michael relates some of his own personal experiences as well as those as a paramedic firefighter with the Providence, Rhode Island Fire Department to shape his opinion that making Narcan available to the public will allow drug users to “push their high to the limit and then return from the brink of death trough the judicious use of the miracle drug that they can now get as easily as they can their drug of choice.” While I respect Captain Morse and his willingness to share his personal experiences with the community at large, I think he is missing the mark here. There comes a time in medicine when we have to weigh the risks of the care and medications that we provide against its benefits and that is exactly what we need to do with Narcan.  I am sure that somewhere in the United States the scenario that Captain Morse has shared with us could happen.  Heck, I’m sure it probably has already happened, but we just don’t know about it, but making this argument is as absurd as saying that someone who is allergic to shell-fish would want to try lobster just once, Epi Pen in hand, ready to bring them back from the “brink of death.”  While I am sure that it has happened, it is the exception to the rule. “What if the drug is given too fast and the patient vomits?” “What if the patient is actually speed balling and comes up violent?” There could be a million and one “what ifs” that we throw out there, much like we could for C-Spining patients, or putting a patient on CPAP.  The medical world is full of “what ifs” which is why every drug commercial on TV is followed by a long list of side effects that I am pretty sure include spontaneous combustion. Rogue Medic will tell you that the problem with an opiate overdose is not Narcan deficiency, and that effective ventilation can...