Sep 22, 2014

A few months ago, I was approached by some friends at a local fire department who were looking for some help developing and rolling out a pit crew CPR system for their people.  I was quick to offer my help after watching the success that Louisville EMS has had over the last year and a half since rolling out their new CPR program.  I felt like I had a good knowledge base and a number of resources, especially after the events of EMS World in New Orleans back in 2012. The EMS officers from the fire department put in a tremendous amount of work developing a new procedure that utilized the department’s strength in numbers, and played off their established fireground culture where every piece of apparatus arriving at the scene of a fire has an assigned role. After the procedure was developed, the rest of the project was dropped in my lap.  They asked me to develop a class that talked about the importance of high performance CPR, the pit crew mentality, and stressed the values that our state had adopted by adding pit crew CPR to the upcoming BLS protocol updates.  I took a couple of months, and developed what I felt was a strong presentation complete with evidence, videos, and plenty of theory. Last week, that fire department opened their doors to anyone who was willing to listen.  They put together a free class complete with a free dinner which, as Greg Friese will tell you, is a great way to get people in the door.  Much to my surprise, ninety people attended the class from a number of different departments.  The feedback from some of the attendees has been great, and I have even been approached by three more departments who want to develop their own SOP, and push CPR in their organization. The entire project was a lot of fun for me.  I have found a love for teaching, and being able to talk about something like running a better cardiac arrest is something that I have become very passionate about.  I could not have done the job that I did without the connections that I have made through...

Sep 17, 2014

As the debate rages on about whether or not “cookbook medics” are the new fad, an interesting question was raised on the Paramedics on Facebook page that sparked some interesting conversation.  The question was about deviation from protocol with an elderly patient that some could have considered a priority to take c-spine precautions on.  I’ll let you read it for yourself: You’re dispatched to the assisted living facility for a fall. You arrive to be met by staff who is escorting you deep into the bowels of the building. During the walk, she tells you that the patient is an elderly gentleman who is under comfort care only, DNR/DNI with all appropriate paperwork, for stage IV liver cancer with metastasis to just about every organ system in his body. He’s accepted it, as has his family. He just wants to die with a little peace. But tonight he tripped on the carpet, and when he fell, he hit his ear on the night stand. There’s a laceration that bled a fair amount. Facility requires his transport for a fall, though. You walk in the room to find the FD strapping him onto a backboard with a collar in place. The patient is alert and oriented. The only visible injury is the laceration to the ear, which has been controlled, but it looks like it needs a couple stitches. He has no signs of injury on his head, neck, or back. He has no neck pain. He had no back pain before the board. The patient says he is in incredible pain since being on the board, and wants off. He’ll go to the hospital, but he’s in agony. His GSC is a solid 15. He’s not stoned on narcotics, and he’s able to understand risks. No history of dementia. Here we have a patient who is alert, oriented and refusing a portion of the care that you are trying to provide to him.  Some will argue that protocol is protocol, and others that he should be taken straight off the board, and the evidence does not support taking spinal precautions of this patient.  Congratulations, folks.  You’re all right. . . kind of. Far too...

Sep 16, 2014

System design has always fascinated me. Throughout my career, it has become more and more obvious to me that design of an EMS system goes far beyond what trucks are on the road, and who is on each of them.  Each aspect of the system from top to bottom effects every other aspect of it.  Those who make the big bucks to make the decision need to find the best balance possible.  Need more medic trucks?  Push to run a “one and one” style system.  Short on units?  Investigate the possibility of first response, or downgrading calls to allow longer response times.  While some look at unit hour utilization and time on task as two of their biggest determinant for the effectiveness of their system it is starting to become apparent to me that much of the success of an EMS system starts at its base when that phone is answered and those first first units are dispatched. Both major systems that I have worked in have utilized Emergency Medical Dispatch (EMD) and Priority Medical Dispatch (PMD) to determine response.  Or at least they have claimed to.  I feel like at this point in my career, I have experienced both ends of the spectrum and I have seen both the good and the bad. Previously, the quality of phone triage was poor.  Even if the right questions were asked, much of the determinant of response rested in the hands of a dispatcher who would read the notes of the call, shoot from the hip, and make the decision based on what they felt was going on.  If the call was for a pediatric patient, for example, the response would almost always be with lights and sirens for no other reason than “because its a kid.”  Calls were rushed and pushed to the dispatcher’s screen in a minute or less in an effort to churn them out. The system I am currently working in has a perception that they take a bit more time when prioritizing calls.  They will sit on the waiting screen sometimes for as much as two or three minutes to allow the dispatchers to make the best decision possible in order...

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:  ...