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...

Fifteen years ago I was just getting ready to wrap up my first semester of paramedic class.  We started in January and ran straight through to December with most of our summer dedicated to ACLS.  My teacher, Gary Childs, was tough on us through the first five months, but once we started getting it, we looked at it less as him being critical and more so of him challenging us.  Many pushed to get in his practical station first and as CJ Bartone, one of my classmates often said, “If you want the bull, you’ve got to take it by the horns!” Through the first two semesters of class, I started a list of what would go on to be known as GAC’isms.  G.A.C. were Gary’s initials, and that is what he put on any check sheet a student might have when they went walking out of class.  This list comprises some of the more common statements he made in class as well as some of the more noteworthy and less frequent ones.  Many of my readers might not completely understand this but I feel like there are many out there that have encountered Gary, either as one of their head instructors at Springfield College, or as a lecturer in some other CEU class.  Enjoy! 1. Then we’re going to turn around… 2. Does this sound like… 3. Do you see where we’re going with this? 4. You’ve got to make the soup. 5. Do you need to know if you’re putting the sugar in the bath tub or in Island Pond? 6. Chase the lion or be chased by the lion. 7. Chase the PVTA bus or be chased by the PVTA bus. 8. Palpate, auscoltate and inspect. 9. A P-Wave… 10. Harley’s going to do his ET(O2)IVMONITOR… 11. That’s a snowball thrown at the police cruiser. 12. Eating the Lion and celebrating eating the lion. 13. The TV set doesn’t know what the cable company is. 14. I want to watch Sipowitz on NBC. 15. We’re hitting the ground running. 16. Its all coming together now. 17. You’ve paid the cable bill. 18. Does this patient need to go to Cooley Dic...

I did some thinking this week in the wake of the loss of two of Boston’s Bravest, Michael Kennedy and Edward Walsh and it is a point that I think the world commonly over looks when it comes to police, fire, and EMS.  We have to deal with death far too often most of the time in the form of the general public and the patients that many of us encounter in the streets.  Death is never an easy thing to digest in any setting but we push on, despite it sometimes being a child, or maybe a scenario that is all too familiar to us that triggers some sort of memory from our own personal past.  We are there to deal with it though, and we are there to help the survivors through the early stages of their loss.  The truck stays in service, and we are ready for the next call.  We are not afforded the luxuries that many other people get. If the person who died owned a business for example, that business might close its doors the day of their funeral to allow their employees to pay their respects.  The employers of their loved ones most likely will give them the day off so that they can properly mourn their loss in their own way.  When it comes to public safety though, there is no day off.  There are no locks on the doors or a sign that we can put up in the window that says “be back in 15!” that expects people to be patient and await the return of someone, anyone who might be working that day. Firefighter Kennedy and Lieutenant Walsh were lost on Wednesday March 26th.  On Thursday morning March 27th, there was a group of brave responders who despite their loss put their own grief on the back burner every time the tones dropped because somebody needs them.  The magnitude of that seemed to hit me today as I read through the outpouring of support for Boston Fire over the last couple of days. When the Springfield Police Department tragically lost Kevin Ambrose on June 4, 2012, I was working.  I was on the...

Through my career I have worked in a couple of different style of EMS systems.  I started out in a volunteer system that commonly saw anywhere between 2 and 4 people riding on an ambulance, cramming themselves in back with a medic and a patient for transport to the hospital.  Despite how big our ambulances were (and granted, they were smaller than many of the ones on the street today) things still felt cramped.  I must admit that from my BLS stand point things seemed to run smoothly.  It was all that I knew.  Everyone had their role.  Things seemed to go well, however, now, twenty years later I can certainly see where things could have been frustrating for an ALS provider. Fast forward a few years to my tenure in Springfield.  There was no predicting who I would be in an ambulance with, and more importantly, how much help I would get if I asked for it and it was actually granted to me.  Sometimes I worked with another medic, sometimes an intermediate, and sometimes an EMT.  I did not mind the work load that was generated by not working double medic because such a high volume of our runs were BLS runs anyway.  Admittedly though, there were certainly some frustrating times in the early years of my career as I felt like I could never get enough done.  I was and am my own worst critic.  When things don’t go how intend them to, I beat myself up.  That seemed even easier when I was the only medic there. On most cardiac arrests, we had a fire engine or ladder company with us ready to do compressions, but they were not always the easiest to give feedback to if compressions weren’t being done well enough, or there was something that needed to change.  Don’t get me wrong, many of them were fantastic but it was certainly a barrier we encountered.  Finally, the question of “how many EMTs do you need to run a code?” was a common question that was asked.  A lack of recognition for the evolution of medicine was something that constantly held us back.  My opinion was always that...

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...