I recently read a story that came across the EMS wire about an EMSA paramedic in Oklahoma City who was assaulted by a patient and as a result, she lost her unborn child.  Last week, I read a story about a politician or lawyer (forgive me, I cannot find the actual article to reference it) who assaulted a medic and was not charged.  Over at Rogue Medic, Tim brought to light a man who assaulted a Chicago medic who got off easy. Our job can be dangerous.  Sure, for the most part, our calls are routine, and we are not at risk, but then there are those cases, like the ones referenced above, where we are put at risk.  When these incidents happen, I’d go as far as to say that paramedics and EMTs are more at risk than doctors and nurses who have other staff there who could potentially back them up, and police officers, who are trained to deal with such situations.  When a provider is one on one with a patient who could potentially become violent, or does become violent, there is not a more dangerous scenario that we as prehospital providers are put in. Some of these tips are my own.  Some of them I picked up from Mike Taigman and the street safety course he was teaching through EMS1.com a couple of years ago. First of all, each of us needs to remember that scene safety carries into the back of the ambulance.  Next time you’re in the back of your truck, take a look at your surroundings.  Where are the potential “weapons” kept?  Are there sheers or IV needles in the cabinet right next to the patient?  Are they accessible on the bench seat?  What do you keep on your belt, and how well is it secured?  Make sure your sheers are always fastened if you carry them.  And although I have not found much of a use for them in my years as a medic, make sure your knife is discretely tucked away. Work a “pat down” into your assessment.  It can be as simple as a head to toe assessment, and can be very discretely done. ...

I posted a question on my Facebook page asking my followers what they felt the “most innovative change” was that they have seen during their career in EMS.  To date, I have gotten 26 responses of varying degrees of seriousness but the most common one that I have seen is prehospital CPAP.  In fact, one nurse even weighed in with that answer.  I decided to do some research and see what else I could find out about the topic. I remember being an EMT in New Jersey home for the summer back in 1999 and watching the LIFE paramedics pull out a large bag with their CPAP setup out of the trunk of their unit.  It was admittedly an intimidating piece of machinery to me.  CPAP in my home system in Massachusetts was as foreign as prehospital 12-Lead EKG’s were at that time.  We did not get LP-12’s until 2002 or 2003. When I did a Google search for prehospital CPAP, I found an article from EMS World written in 2005 by my good friend Bob Sullivan outlining its use, why it is effective, and why it is so important to start CPAP sooner rather than later.  Some of his references in the article date back to as early as 2000.  The proof has been in the pudding for years, CPAP works. Why then did it take a special project waiver and two years of evaluations to get it approved for use by paramedics in Massachusetts?  Randy Cushing, a paramedic with the Agawam Fire Department was one of the leaders in the push for prehospital CPAP and his efforts finally paid off in 2010 when the change went through in the state protocols giving paramedics standing orders for prehospital CPAP.  Eleven years after I was seeing it used in New Jersey.  Five years after the article, one of many, was posted about its effectiveness in prehospital care.  This leads me to make the broad conclusion that in 2013, there are still probably some systems out there that don’t use it, or haven’t gotten full approval to use it yet. This makes me think about studies such as the one that compared usage of IM...

First of all I would like to thank those of you who commented on my post entitled Stress the other day.  There were some great words of wisdom there, and Bob Sullivan from EMS Patient Perspective shared some links to some really good articles. Greg Friese asked what I do to help those around me with stress.  Personally, I feel that as a field supervisor it is my responsibility to have a grasp on the mood of my employees.  That is a daunting task since I have around two hundred paramedics and EMTs, some full time and some part time, working in my service.  I personally need to be able to watch as many of them as I can for mood changes, and when I see them I need to be able to refer them to the places where they can get help. The resources available to them can be as simple as a walk through the garage and a friendly conversation or it could be a phone call to muster up our regional CISM team.  Additionally, EAP is a great route to refer employees to especially if the root of their issue lies outside of work. Most of all, the most important thing that any leader can do for their people is make themselves available to their employees whenever they may need to talk.  This needs to be a team approach though.  I know all too well that I am not the first choice for everyone to come and talk to.  Personalities clash, and frankly, not everyone gets along all the time and they cannot be expected to do so.  Thankfully, there are a number of other people on my management team, and for the most part, most EMS services are not a one leader shop.  If someone says, “I dont want to talk to Scotty about this” that is fine.  I don’t need to be their sounding board.  The important thing is that they go to someone about it. Availability and access.  That is what is most important.  People cannot get help if they do not know where to find it.  My advice to those in the field is to find someone...

Quite often I see some EMS news story come across the wire about how a paramedic neglected to care for a patient as they should, or delayed a response, or in extreme cases were involved in some sort of serious altercation resulting in the injury or a patient, a tech, or their partner.  With every story I read, I get more and more concerned about the state of EMS, and the people who are providing care.   While none of the situations I’ve read about are excusable, I think it is our responsibility to find the root cause, or at least minimize the chance of these incidents repeating themselves.  Personally, I feel that while stress is not an excuse it is a huge factor. As a community it is our responsibility to give each and every provider not only the access to the training that they need to best provide care but we need to police our own to make sure that every provider is fit enough to provide that care. Recently I read a story about a paramedic who was arrested for assaulting a patient.  While there is no excuse for his actions I cannot help but wonder what signs and symptoms this medic showed prior to the incident occuring.  I am not talking about during that shift but more in the weeks and months leading up to it.  When did they start to turn?  When did their attitude really start to decline?  Most importantly, what did anyone do about it to try and turn this person around? A lot of it points towards the question of “how busy is too busy?”  Of course one must also ask if this is the job for them, but the EMS industry is so  focused on a single mission which centers around getting people to the hospital.  While a typical day on the ambulance can offer a large variety of calls, the sheer volume and type of calls can certainly create a stressful environment.  As those days compound into weeks, weeks to months, and months to years, each individual day becomes a contributing factor towards what could eventually become a burnt out paramedic. I have written...

I’ve been thinking a lot about cardiac arrests, CPR, and the barriers that I face in the system that I work in.  Chances are, if it is a problem here then it is a problem somewhere else, which makes it worth talking about. In the system that I work in there are two types of dead people: people who are not workable; that is to say, they have some injury incompatible with life, or conclusive signs of death.  The second kind is one that ends up on a stretcher in an emergency room.  That’s right, if you get CPR, you get a ride to the hospital. After doing some research earlier this year for a class I was teaching about running a better code, I found a clip from Wake County, North Carolina where their medical director Dr. Brett Myers talked about the key points to the quality of cardiac arrest that they provide.  The one big one that stuck with me was “Don’t move them.  Work them where they drop.”  I realized very quickly that Wake County had one very important component to high performance CPR that my system lacked. Over the last two years we have learned a lot about quality of compressions and their importance.  Anyone who has taken ACLS or an ACLS refresher has heard that you never stop compressions, or at least you greatly minimize interruptions but what they fail to address is the importance of knowing when to say when and affording us enough options and guidelines telling us when to stop CPR.  Actually, let me rephrase that.  The content and evidence is there, but a few systems have chosen to ignore it. So am I saying that knowing when not to do CPR or when to stop doing CPR is an important piece to improving ROSC rates?  You better believe i am.  Let me describe a common cardiac arrest in my system: The crew gets on scene to a confirmed code with fire department first response and more times than not, a second ambulance is coming behind them to assist.  When that truck arrives, the patient is loaded into the best way to extricate them from where...

How good of a paramedic are you?  Have you ever wondered?  Well, lucky for you there is some proof in the numbers.  Getting an idea of how well a paramedic does their job is not as hard as some people think, and with a little bit of research it is easy to figure out how successful your patient care is.   With data collection what it is today, one can look at things like their IV and intubation success rates, or their time to STEMI recognition or even their scene times for trauma calls to make sure that they are, in fact, within the Platinum Ten.  The rest of the job though you are going to have to judge from yourself, from your gut, or simply ask your partner: “how good am I with my patients?”  Bedside manner might be the most vital skill that we all possess in our toolbox and while tools such as patient surveys might give a single provider or a service a better idea of how much compassion and empathy their employees show towards their patients it is largely immeasurable. When talking about employee surveys with a colleague a few years ago, he told me that from his experience with them they were largely polarized.  The surveys that were returned from patients usually either gave a glowing, favorable review of the providers or a scathing dissertation of how poorly they were treated.  Those people who fell largely in the middle rarely said that the care was “just okay.”  One is left to assume then that all of those unreturned surveys, sometimes three out of every four, reflected that the providers did in fact do nothing more than an adequate job. Adequate should not be viewed as a bad thing, and don’t think that I am trying to paint that picture.  Lets face it: you are not going to be able to please everyone, and someone who is sick or injured will most likely be exponentially more difficult to satisfy.   When reviewing patient feed back, I have seen all sorts of complaints: “The ride was too bumpy” “the driver took a longer route to the hospital than he had...

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...

Its slightly ironic that as I write this post, I am lying on my couch, heating pad on my back, and a cat on my lap holding me firmly to it.  Yes, I, like many in EMS, have a bad back, and an old nagging injury has reared its ugly head.  Thankfully, my flareups are few and far between (knock on wood) but they still happen, and when they do, they suck. The strives that we have made in back safety in EMS during my career have been huge.  We have added a number of devices to help us along: stair chairs with tracks on them, stretchers with hydrolics that are raised and lowered at the touch of a button. even stretchers that load themselves.  In Australia, ergonomics is extremely important to EMS.  They are using lifting techniques, slide sheets, and moves that I hope one day make their way over here to the western world as it would do nothing but benefit us.  Still though, the possibility for a back injury exists, and I feel that the biggest risk comes from a topic that is currently extremely controversial: backboarding. So how does backboarding a patient result in potentially landing on one yourself?  Think about lifting a backboard that is flat on the ground.  Think about how difficult it is to use a proper lifting technique to get that board up.  I am 6’5″ (although I claim I am 5’9″) and let me tell you, its a long way down for me to get that backboard.  I don’t enjoy it, and my lifting technique admittedly probably is not the best, but I do the best I can with the body and its mechanics that I was given.  The lesson for this one is simple: do the best that you can, and make sure you have enough help if needed.  Keep the stretcher as low as possible (all the way down if it is not a manual one) and try and minimize the lift as best you can. Most of all though, don’t let yourself get complacent.  When we are not lifting as much as we used to we get comfortable with that, and when...