Scene Safety in Jackson, Mississippi

Battle On Over Emergency Response Vs. Emergency Caution – Jackson News Story – WAPT Jackson Jackson, Mississippi is back in the news, and Councilman Kenneth Stokes is at it again. Take a look at the video that I linked above, and reread my previous post on this issue. Why doesn’t Kenneth Stokes see what the problem here really is? Its not faster ambulance response, its a larger police presence. The question at hand is should an ambulance respond into a potentially dangerous scene until it has been secured by the police department? My training and my gut both tell me NO. Kenneth Stokes recommends bullet proof vests for AMR’s staff, but a vest isn’t a magical suit of armor that will keep you safe. The right angle to take of all of this is to promote safety at the scene. Bulk up Jackson’s police force. If the city is that unsafe that this has become so much of a problem, make it safer. Expecting AMR’s Ambulance staff to do some of the police’s work for them is unfair, and it puts more people at risk. But, remember, that would cost tax dollars. Its much cheaper to drag the Ambulance Company through the mud, encouraging them to drive into potential “war zones” and put themselves in the line of potential danger. I looked up some information about Jackson, Mississippi. It ranks 4th in the nation for homicide rates per 100,000 residents behind Baltimore, St Louis and New Orleans. In 2009, it was ranked as the 23rd most dangerous city in the United States. If anything should scream for a larger police department, that should. It doesn’t give Jackson the portrait of being a safe city, or a safe place for EMTs and Paramedics to work. What Councilman Stokes is doing is making it more dangerous for the Paramedics and EMTs in Jackson, Mississippi. He’s setting them up so that each time they walk into a scene after the police department, the perception could be “What took you so long?” Every time a truck is posting in a parking lot, or waiting for police to arrive at the scene, it will spark the question of “What...

Lesson Number 1

Think back, if you will, to the first EMT class you ever took. It might have been a few months ago, or for some folks, it might have been 20-30 years ago. Now, think about what they taught you about your own safety, and what is most important when you hit the streets. Lets take it a step further. Think now about any EMT Practical exam that you’ve taken, whether it be for your EMT-Basic certification right on up to your Paramedic. Lets take the Assessment station. You walk into the station, stethoscope around your neck, with a State or National evaluator sizing you up and staring you down. You look over your station, and indicate you are ready. Your evaluator looks at their sheet of paper, and begins reading the same scenario that the person before you most likely just heard. It could be a car accident, a shooting, or something as routine as a fall, abdominal pain or a chest pain call. Regardless of what the nature of the “call” is, you take the information in, and start your station the same way. “Scene safety, BSI, number of patients.” You might use different terms depending on where you’re at, but the intention is always the same: Is the scene safe for my partner and I to enter? Do I have the necessary protective equipment on? Do I have the resources I need initially to handle this incident? Now, keep that in mind, and read this article that has made its way around the internet: http://www.wlbt.com/Global/story.asp?S=13191657 Take a moment to compose yourself, pick your jaw up off the floor and stop screaming at your computer. I’m sure you’ve already asked out loud, “What is this guy’s problem?” AMR has not written a policy that needs to be changed, the responding crew followed their training perfectly, and did the right thing by not putting themselves in a dangerous situation. If any other Ambulance service, Private, 3rd Service, or Fire based told their crew to just rush in there, I’d question their devotion to their Field Employees. Tim Noonan over at RogueMedic.com has said it better than I could have. The blame here has been...

The Hurdles We Must Overcome

I was looking through some old files and articles that I bookmarked, and I found last year’s Career Cast Worst Jobs of 2009. Emergency Medical Technician was ranked as the 6th worst job in the United States using Physical Demands, Stress and Income as criteria. That’s right, everyone, this job that we all love to do, some of us as volunteers, others as our careers, is ranked as one of the worst jobs in the United States. In case you’re curious, Sailor, Taxi Driver (does anyone else find humor here?), Diary Farmer, and Lumberjack were the only jobs that were considered worse then EMT. So, how in the eyes of the folks at Career Cast, can we improve the Emergency Medical Technician position as a job? Let’s take a look at their criteria: 1. Physical Demands — We are already moving in the right direction here. The physical aspect of EMS is greatly diminished thanks to innovations such as tracked stair chairs, hydraulic stretchers, and AutoPulses. Although there is still some wear and tear, and the necessity to lift will always be there, as an industry, we are doing the best that we can for our people. 2. Stress — Stress will be the hardest piece of this puzzle to improve on. Let’s face it, we see things every day that some couldn’t imagine seeing in a lifetime. The best thing that we can do is afford as many outlets for stress relief for our employees. That could come in the form of increasing the availability of Critical Incident Stress Debriefing, or something as simple as giving our people other outlets for their stress by giving them something as simple as gym membership. 3. Income — With the progression of our field, the expansion of our scope of practice, and better understanding of what we do, Income will improve as well. EMS is still a very young field when compared to the other two branches of public safety. We have come a long way in a very short time, but we still have a long way to go. Interestingly enough though, in 2009, USA Today ranked Fire Fighting as one of the best most...

To Refuse or Not to Refuse?

There is no higher liability situation for a Paramedic or EMT than a patient who does not want your treatment. Nationally, on average, approximately 20-25% of all 911 Ambulance calls result in a non-transport, so refusal scenarios are encountered frequently. Determining orientation to person, place, and time is one thing, but feeling confident that leaving a patient is in their best interest is something completely different. My old Medical Director used to tell us, “I would rather have you take someone to the hospital, even if they disagree with your decision and find nothing wrong, than to let them stay home, and get worse, or even die.” Some cases are pretty cut and dry. The patient understands the potential consequences of their actions, which may or may not include death or permanent disability. Others, like the incidents listed below, aren’t quite to black and white. Take a look at these three unique cases in which a patient was refusing treatment and tell me what you would have done. . . Case #1 — The Overdose We are called for the 30 year old possibly not breathing, with CPR instructions being given. Upon arrival, we find a 30 year old male, with a pulse and a respiratory rate of 4. Family was doing CPR upon arrival. Upon further assessment of the patient, we find his pupils to be pinpoint. Family is stating that they found him like this in the presence of a needle and heroin. The Medics on scene go down the usual treatment route: assisted ventilation, and the establishment of an IV. They decide at this point that they want to get their patient conscious, so they give him an initial dose of 0.8 mg of Narcan. After about two minutes, there is a minimal response from the patient. He is still unconscious, and his respiratory rate is not significantly improved. The lead medic makes the decision to give the patient another 1.2 mg of Narcan, bringing our total dose of Narcan administered to a whopping 2 mg. The patient then regains consciousness. While grateful for the treatment the patient has received, the patient and his family who was previously doing CPR on...