I admit it, I’ve slipped and stumbled.  My blog has been reduced nearly to the occasional urban tumbleweed (read: plastic bag) that kind of blows through every so often.  With high hopes for content, I have not nearly been putting out as much as I would have liked, and you know what?  It’s my fault.  It’s all my fault. While I was expecting big things for 2012, and I seemed to start off on the right track, the last few months have not been quite as fruitful for a number of different reasons, many of which will become more clear in the coming months. One thing is for sure though: I need to get back to what is important. I have been reminded a lot of why I really enjoy this online community lately, and why I am so passionate about EMS.  I had a chance to speak to the guy who made this all possible for me: the one who set me up in Oakland that opened my eyes to the Chronicles of EMS.  I have talked to a few people who I truly respect about the direction of my career and my potential future and have gotten nothing but support.  To those people: you know who you are, and I thank you. Above all else, I need to get to what is important to me: writing, being a good paramedic, a good supervisor, and a strong advocate for the industry and frankly, there is no better time than now for me to get cranking on that.  I am in a holding pattern at the moment, treading water if you will.  The NREMT-P card is in my pocket along with my PALS, PHTLS, and a new ACLS card.  It took a lot of hard work, and I am ready to put forth that sort of effort here among other places. I think that getting everything back on track is just what medical control ordered.   To all of you who have been faithful readers during the last year and a half, I am sorry I have neglected you.  I will tell you that I plan on continuing to write this blog for myself,...

Please be advised that the video does contain some language which might not be suitable for all viewers. In case anyone hadn’t realized it by now I am a huge fan of the HBO series The Wire.  I think it was one of the best directed, written, and acted shows I have ever seen.  I own every season on DVD, and I think I’ve been through every episode two or three times.  This is one of my favorite scenes, and I feel like it presents an interesting metaphor. Think of the desk as the current state of EMS today.  Everyone has an agenda for it, and has the intention of moving it in the direction that they feel it should go, whether that is where it belongs or not.  The one person who has the knowledge for the desk’s proper destination fails to speak up simply assuming that everyone else around him is already in the know, which they aren’t.  So he starts pushing.  From the opposite side, they start pushing.  More people arrive and decide that they know what is best, they take up their positions and start pushing as well.  What are you left with?  One big stalemate.  No progress. So what’s the answer?  In the video it is simple: everyone needs to shut up and decide as a group what needs to be done, and how to do it the right way.  In real life it is a bit more complicated.  We need a unified direction, and we lack that.  The NFPA sets one standard while evidence based medicine suggests another.  Some preach prevention and proactive medicine while others still insist on code 3 responses by multiple agencies to nearly every request for assistance.  Which is it going to be?  Do we want a fast, timely response or one more gauged towards what is medically efficient? Let’s pick one and stick with...

For the past two semesters, I have had the pleasure of doing the opening lecture to an EMT class at a local college.  This means I get to stand in front of a lecture hall of enthusiastic and often terrified EMT students who have no idea what to expect.  My lecture is called “So, You Want to be an EMT?”  Its purpose is to give the students an idea of what to expect out of EMS both as a career and as a provider.  I do not talk about patient care all that much, the lecture is more about stress management, the qualities that an EMT needs, what calls are really like, and also a generalized 50,000 foot view of EMS. In addition to all of that, I also talk about finding the right fit.  I explain to them that one of the beauties of EMS is if you don’t like the system that you are in, all you need to do is drive down the road and you can find someplace else to start over that might work a little better for you.  In the recent months that has been something that I have had to tackle as well, and it has left me asking myself a simple question: “what is the perfect EMS system for me?”  What I have tried to do is sum it up into five qualities.  Here is what I came up with: 1.  EMS centered – I want a system that is dedicated to EMS.  They need to be focused on patient care and encouraging the growth of their providers.  The focus cannot be on profit, justifying call volume or fire surpression.  It needs to be all EMS all the time. 2.  Horizontal career opportunities – This was a term that I heard Skip Kirkwood use a couple of years ago during a lecture at EMS Today.  The career path in EMS cannot and should not be solely vertical.  There needs to be opportunities for the street level providers to contribute to the organization with steering committees, study groups and assignments beyond the street.  This creates an environment where paramedics are encouraged to be involved with the growth...

Nothing seems more satisfying than when hard work pays off.  I set the bar high for July.  I knew I had some work to do, and I had to make sure everything was done, and everything was in order.  That meant getting my PHTLS recertified, taking PALS again, updating my ACLS, and obtaining my National Registry certification.  While that just seems like four classes, it is a lot harder than one might think. The first thing that I realized was PHTLS classes are very hard to come by.  I did, however, luck out and find one class down in Connecticut at the end of the month.  That would be the last piece of the puzzle, but it was scheduled.  PALS was the easiest of the group.  I found a class pretty quickly and got that squared away.  ACLS?  They’re a dime a dozen.  Scheduled, and done.  No problem. Then there was my National Registry paramedic certification.  That’s right: the Quest for the Disco Patch.  This was the one that terrified me the most.  Being twelve years out from any EMS related exam that I had taken, and eleven years since I took any standardized test, I was a touch nervous.  Add to that the fact that I felt the pressure of actually being a provider, and I was then really nervous.  I scheduled the written first, followed by the practical more towards the end of the month. I studied almost every day for three weeks.  I would take practice exams, then study what I got wrong, and then take another one trying to absorb as much of that supressed information as I could.  When the test day came, I was a wreck.  I sat down on a Thursday afternoon and fired up the computer that I was put in front of and cranked through 87 questions.  Yes, that’s right, just 87.  I got there, and it shut me down.  “You have completed this exam, and will get the results in two to three business days.” Headache number one was gone by Friday afternoon.  NREMT was quick to get me my results, and I knew my written was all set.  Then it was on to...

I was working at my part-time job the other day, and we got into a lengthy discussion about Do Not resuscitate orders and when to honor them versus when to treat a patient.  Today, the conversation continued and we came up with an interesting scenario, and I wanted to see what everyone out there thought both from a moral/ethical stand point as well as a legal one. Here’s the story: You are called to the home of an 80-year-old male who lives alone.  His neighbor frequently checks on him.  Today, his door is locked, which is unusual.  Your unit arrives at the same time as the fire department who is there to help you gain entry and assist with patient care. You enter the patient’s apartment and find him supine on his couch.  His breathing is clearly agonal and you cannot detect a pulse.  In plain view sitting on the coffee table in front of him are the following: A bottle of hydromorphone which was filled two days ago.  The cap is off and the bottle is empty. An appropriately filled out Do Not Resuscitate order which clearly states that the patient does not wish to have CPR performed on him. A suicide note stating that he had been recently diagnosed with cancer and does not want to live anymore.  It outlines what he would like to be done with his personal effects. What would you do?  Would you start CPR on the patient?  Would you honor the DNR?  Does the suicide attempt void the presence of the DNR? Normally, I would expect a bunch of comments on this topic to say “I would contact medical control to see what they would like me to do.”  While I understand that, I would like to know what YOU would do as a provider. Also legal folks, I know you’re out there, what do you...