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...

Dec 21, 2014

Saturday’s cold-blooded murder of two New York City police officers has rocked the public safety world.  The best emotion that I can come up with for myself right now is I am angry.  Extremely angry.  If you connect with me on any form of social media you have probably already seen some of my thoughts about it either reposted in the words of some of those who I follow, or in my own original thoughts.  I feel like many, many people have failed the NYPD.  The media has failed them, the mayor of New York City has failed them, and society in general has failed them.  They have not gotten nearly the support that they deserve for the incredibly difficult job that they do, and that is what i want to write about today: support, but not for who you might expect from the tone of this first paragraph. It is currently 2:30 in the morning.  I am at work, and I have been combing my Twitter feed for the last thirty minutes or so since I got back to the station from my most recent call.  That is when I saw this tweet posted by the NYC EMS Website’s Twitter account: “. . . no one talks about it but all the EMS EMT’s & Paramedics who responded to the 2 NYPD Police Officers who were killed carry a heavy load.”  Far too often, the involvement of EMS is so quickly forgotten.  I know, because I have been there. I briefly mentioned in a blog this Summer a call that I did back in 2012 for an officer who was shot and killed and it was by far one of the most difficult runs that I have ever been part of, and it is amazing the difference that two and a half years can make.  Just because of the incidents in New York City and Ferguson, Missouri this Summer, the climate in this country when it comes to not only law enforcement but all branches of public safety is rapidly changing. A call like this one can completely change someone.  It can ruin a career, and it can ruin a life.  If ever...