May 19, 2012

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Gotta Love Nursing Homes

May 15, 2012 By Leave a Comment

My primary job has a contract with pretty much every nursing home pre-mortuary in the city. As anyone who’s been doing this for any length of time can attest, nursing homes come up with some crazy reasons to send patients out.

At 0h-dark-thirty.

Now before I go any further with this and manage to piss off every nursing home employee who might find this post, let me just say that I highly respect the work that they do. I fully admit that there are many nursing home nurses that I have had issues with (and continue to have issues with to this day for various reasons) but the vast majority of nursing home workers are very good at what they do, better than any nurse in a hospital. Just by the sheer amount of junk they have to put up with, they are special people. However, we all know that a good many are there just to get a check and couldn’t care less about the residents inmates.

Unfortunately, the same can be said about us… but that’s another post.

Anyway, one night about 2:00 AM, my truck was dispatched to a facility for a patient whose peg tube had clogged. The patient is in bed, in no apparent distress and all vitals are within normal limits. The CNA (apparently the RN on duty was busy elsewhere) told me that they tried to feed him and give his crushed meds and that the tube was apparently clogged. I asked about the patient’s history and meds and I got the answer that seems typical on nursing home EMS calls:

“I’ll have to check the chart, I’ve never had this patient before.”

I knew for a fact that wasn’t true but I let it slide. Finally I asked how long ago they discovered that the tube was clogged.

“Around noon when we tried to feed him his lunch.”

Yeah.

She also didn’t like when I informed her that if the ER was unable to unclog the tube that he would be sent back shortly with an appointment for the GI lab for Monday (this was an early Sunday morning) to have his tube replaced. She apparently didn’t understand that the GI lab is an 8 to 5, Monday through Friday deal.

Calls like that make me appreciate the calls at the good facilities even more.

I tip my hat to the many great nursing home CNAs, RNs and others out there and I appreciate them more than they’ll ever know (especially since my grandmother was a nursing home patient who was thankfully very well cared for). However, if I could ask one thing of them I would ask that they police their ranks (again, just as we should but that’s another post).

The bad ones are making you all look bad.

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Happy Retirement, Mr. Liddy!

May 6, 2012 By 3 Comments

In a previous post I wrote about the plight of our brothers and sisters at Detroit Fire and EMS, specially as told by author of The E.R. Loading Dock, Eric Liddy Sr. He will often post of things going on in the D and his life on the fan page for his book. To hear Eric tell it, things in Detroit are even worse than we thought. Recently he posted about some of the same issues that he has discussed recently (staffing issues, substandard equipment, more trucks in the shop than on the streets, etc.) but he also said something that I had not considered and something that most people are clueless to.

According to Liddy, the majority of DEMS personnel with five or more years under their belts have some form of PTSD (Post-Traumatic Stress Disorder).

Most lay people wouldn’t fathom that EMTs and medics would suffer from a stress disorder that is most commonly associated with those in the military but Detroit’s EMTs and medics are exposed to so much violent death that they might as well be corpsmen. Unfortunately, like pretty much everyone else in EMS, they’re all overworked, underpaid and are essentially the red headed step children of their city.

Did I say city? I meant “cesspool.” Maybe “warzone” would be more accurate.

I’ve never been able to understand how Eric and his co-workers have been able to withstand all of the issues they face – and then there are the patients – but somehow they keep on keeping on. I know I wouldn’t last one shift there so I ertainly salute them.

Eric has been very outspoken about issues with Detroit Fire and EMS and I’m sure the brass hasn’t appreciated it. However, I’m glad that he’s spoken out. Maybe because of his raising alarms things might improve.

Recently Eric announced that he will retire from Detroit EMS next month in order to spend more time with his wife who has been battling serious health issues as of late. He plans to continue in the field with his county rescue squad and he may also teach. I don’t know Eric personally but I’ve been following all of his commentary and I know he deserves this retirement. I’m thrilled for him but at the same time I can’t help but he saddened.

EMS suffers from so much instability due to a myriad of issues but one thing that seems to rear its ugly head from time to time is lack of dedication. The average career in EMS lasts 5 years so having well seasoned and dedicated veterans is very important for us. People like Eric are a rare breed and I hope that Detroit Fire and EMS someday realizes that they are losing a very important cog in their machine.

As for Eric, I know his life has been forever affected by the astounding amount of suffering he has had to see and endure but maybe with this retirement he can start getting somewhat back to a normal way of life. I especially am happy that he’ll be able to spend time with his wife and help her in her recovery.

Mr. Liddy, thank you for showing us a side of EMS that we often don’t like to think about. Thank you for your insights and thank you most of all for serving the people of a city that needs competent and dedicated people to help them. I also want to thank you for something you might not expect.

I want to thank you for having the guts to put your family first – something we seem to suck at – and for being able to admit that enough is enough.

Enjoy your retirement, sir. I look forward to hearing how how goes for you and how your wife’s recovery goes.

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Kidnapping Patients

February 26, 2012 By 11 Comments

Kidnap a patient and this could be your reward.

I was going to make this post about our current drug shortage but today I saw something on Facebook that kind of got my blood boiling. I suppose I just need to get something out of my system.

I’ve mentioned before that part of the reason that EMS isn’t seen in a more professional light is largely our own fault. We have lax education standards (although things are getting better, we still have a long way to go), we work ridiculous shifts, we don’t get enough rest and we also have  tendency to make poor choices in our care.

Cowboy medicine is not going to help us.

I was surfing around Facebook this morning and I came across the page for “The Most Interesting Ambulance Crew In the World.” I have no idea who runs this page but they always post funny EMS related stories and pictures. Sometimes discussions break out in the comments. Today it related refusals from patients who are residents at skilled nursing facilities pre-mortuaries.

In most states, the law says – basically – that if you take someone against their will somewhere they don’t want to go, you are guilty of kidnapping. As it relates to EMS: If we have a patient who’s alert, awake and oriented to person, place time and event and they are competent to make their own decisions, we can’t take them to the hospital unless they want to go. Of course, circumstances such as someone who’s suicidal, under the influence or someone else has a power of attorney make things different. Otherwise, we can’t take them go if they don’t want to go. Period.

A few people were posting that such actions are not kidnapping (it should be noted that laws do vary from state to state so be sure to check our local jurisdiction’s laws). One comment stood out and really made me mad. A poster by the name of Greg said:

That’s how we loose (sic) contracts everyday…now we are laying off 5000 Nationwide (sic)..Strong work guys!

What I take from this comment: “It’s OK to kidnap patients because it helps us keep our jobs!”

Seriously?

I don’t know about you or Greg but I am not going to force someone to go to the hospital when they don’t have to if they don’t want to. As I said above, sometimes certain circumstances warrant that we transport against someone’s will but if a person is capable of making their own decisions is it really fair to force them to go?

Would any of us want to be treated that way? Would any of us want our family members treated in such a manor? I know I wouldn’t and I would be pressing charges if it ever happened to me.

The number of medics and EMTs who seem to support Greg’s statement is scary. It’s no wonder people view us as cowboys, we act like cowboys. Forcing people to be transported who don’t want or need to be transported simply to “get our numbers up” is one of the lowest things we can do. It’s the same as starting a 14 gauge IV for no good reason or performing RSI on someone just to shut them up.

We can’t secure our jobs by doing things that are illegal. It’s also a good way to end up in prison.

Why do we allow such behavior among our ranks?

One step we need to take in order to be recognized as a real profession is cleaning up our ranks. We need to get rid of those who have the cowboy mentality. They do us and our patients no good and are everything that’s wrong with EMS. People like them are the reason that EMT and paramedic education is largely a joke. They’re the reason why people don’t take us seriously. They’re the reason why doctors and nurses don’t trust us.

We want to be professional, do we? I’m all for it. But first we need to start being professional. Until that happens, we’ll remain the red headed stepchild of medicine.

Captain Versed, anyone?

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I am NOT an Ambulance Driver

February 22, 2012 By 16 Comments

With all due respect to my much esteemed colleagues Kelly Grayson (who uses the term “ambulance driver” mostly in jest) and the writer being Captain Chair Confessions (henceforth called “CCC”), this post is in rebuttal to the notion that it’s OK in the year 2012 for the general public to have the perception that we’re all just a bunch of happy go lucky, zany and otherwise inept ambulance drivers.

Back in the very infancy of what we today call Emergency Medical Services, ambulances were largely a side enterprise of the local undertaker and sometimes the local hospital. In most cases when an ambulance was called, a crew consisting of a driver and someone to sit with the patient (if the patient was lucky this attendant would have some sort of first aid training) would screaming to the scene in a converted hearse with a red light and siren, load the patient and go screaming to the hospital. Care en route might consist of oxygen if even that. In 99% of these calls, ambulance service was nothing more than simply a ride to the hospital in which the patient could lie down. Of course today we are capable of much more than simply giving a ride to the ER (whether all patients need more than that is another debate). Today we are more or less a mobile emergency department that renders sometimes life saving treatment on the way to the hospital as opposed to giving the patient a ride, some oxygen, a pat in the head and a prayer than they’re still alive when everyone arrives at the hospital.

We’re medical practitioners.

As cliche as it probably sounds, I didn’t go to school for two years to learn how to drive an ambulance. Yes, I realize that sometimes I do drive the truck (usually on the way back to town after a long transfer) and I realize that the EMT on a 911 ALS truck is often the driver but I and that EMT are hardly simply drivers of a big white box on wheels with red lights and a siren.

CCC has no doubt received many negative comments about his assertion that we should “get over” being called ambulance drivers. Many have suggested that calling a nurse a “butt wiper” or calling a firefighter a “hose monkey” isn’t any better (and it’s not), he (I assume CCC is a man anyway) says:

It would be inappropriate call a nurse an “Asswiper” because, again, that’s not what they do. Sure, nurses are occasionally tasked with cleaning bowel movements. It’s a thankless part of a noble profession. Nurses spend the vast majority of their time assessing patients, writing care plans, completing orders written by physicians, and taking care of sick people. They certainly don’t spend 75% of their time wiping asses.

He’s absolutely right. But EMS is also very similar. It’s a thankless job in which we spend 24, 48 or more hours at a time away from our families – often with little sleep – and we write PCRs, follow protocols written by physicians and take care of sick people (whether they are or not). Yet, if someone calls us am ambulance driver we should just shrug it off?

Not this medic.

When it makes sense to do so, I will correct someone who calls me an ambulance driver. The blood, sweat, tears and time I gave getting my patch were too preciously given for me to just accept someone thinking all I do is driver an ambulance for a living. While we do drive the truck, it’s not all we’re capable of doing and the term “ambulance driver” implies that driving is the extent of our training. True, I pick my battles just as we all should but there are times when we have to stand up for ourselves. It doesn’t make sense to allow the public to continue having an untrue viewpoint of what we do. If we want to establish EMS as a true profession and a part of the healthcare system we have got to start having some pride in ourselves. We have to start standing up for ourselves.

If we don’t stand up for ourselves, who will?

No one.

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National EMS Assessment: My Observations

January 9, 2012 By Leave a Comment

A document detailing data collected during the National EMS Assessment was released by the Federal Interagency Committee for Emergency Medical Services (FICEMS) and it’s very telling about the state of EMS at the state and national levels. I’m still working through reading it (you can find it here but it’s a 550 page PDF – consider yourself warned) but some of the findings listed in an article on EMS1 provide a good summary. What do I have to say about the findings?

We have a long, long way to go.

We as a branch of healthcare and we as a profession are nowhere near where we should be.

One of the things you can notice on EMS1′s summary is just how non-seriously the states seem to take EMS. It’s no secret that government as a whole tends to look at us as a necessary evil, something they have to provide but really don’t give a rat’s ass about. You can tell by now they seem to view us. Among the highlights:

  • One (!) state monitors injuries suffered by EMS providers on the job.
  • 18 states monitor LODDs.
  • 11 monitor EMS crash data.
  • 7 states monitor blood-borne pathogen exposure.

I wonder how many states monitor similar data that’s relevant to other branches of healthcare and public safety. I would imagine it’s a lot more than these numbers reflect for EMS.

The message that I get from a lot of the findings is that most states really don’t give a rip about us. We’re expendable ambulance drivers whom they need not be too concerned about because there’s always someone ready to take over for us should we be killed or maimed on the job. Quite frankly these findings deeply concern me. We must seek to change this status quo.

We have to prove that we are essential and that we are more than ambulance drivers.

One other finding really stood out:

EMS professional education is most commonly a certificate and not a degree. Movement should be toward a degree but cost and access to programs are currently limited.

Really, what’s the incentive to have a degree over a certificate and a patch? I have an AAS in Paramedicine and I feel that education is extremely important but when one is looking at degree vs. certificate options, why should they choose the degree path when most EMS agencies don’t care? I get no more pay for having a degree than the medic who only has a certificate. I’m sure that’s the case at the vast majority of EMS agencies.

Aside from personal satisfaction, I fully understand why someone would choose to have a certificate. Until employers make it worth the time to get the extra education this trend will not change.

The National EMS Assessment gives us some good points and great data that we can use to get pointed in a better direction. To me it just helps prove our case. We are essential, we do provide a service that affects everyone in some way and we’re much more than ambulance drivers. The question is: Will anything change because of this data that we have to back us up?

That’s really up to us, isn’t it?

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Here’s to 2012

January 1, 2012 By Leave a Comment

I just wanted to take a moment from celebrating the new year with my wife to wish you a very happy new year. I chose not to post a retrospective of 2011 mainly because I felt that it’s something that bloggers do to death and there’s just no need it in.

Why dwell on the past?

2011 was a great year, though, and I’m thankful for all of the memories and positive changes that have come about in the last year. I’m even thankful for the not-so-good moments because they’ve all helped me to grow as a person and as an EMS practitioner. I hope that you have had a similar experience.

If you’re working tonight: Stay safe. If you’re out partying: Stay safe. Don’t drink and drive. The rules are the same for party people as the are for EMS: Everyone goes home.

Happy new year! Here’s to a wonderful 2012!

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A Call No One Wants

December 19, 2011 By 4 Comments

The truck was checked off and I had my coffee in hand. An EMT-Basic student had been assigned to me and I was showing him around the truck and showing him where everything was stored. He was asking a lot of good questions and I found myself very impressed with him and his initiative. Then the radio crackled.

“Control to Medic 51. Respond to Section 8 Apartments, apartment 22. Have a 7 month old female not breathing.”

“Oh SHIT!”

My partner ran to the truck and I told the student to go ahead and glove up, as Section 8 Apartments is close to our station. I’m praying the entire way over there as was my partner I found out later. Medic 16 went en route to assist and I was very glad since this was the first “kiddie code” I had ever gotten in my EMS career and a big part of me was scared to death.

We go on scene and the fire department is already there. Before I could approach the apartment I see one of the firefighters running out with the baby in his arms. “Bring her to the truck!” I yell out.

Mom is hysterical. “Please help my baby!”

“We’re going to do everything we can ma’am.”

The other medic who responded was already in the captain’s chair ready to tube so I grabed the IO gear.

“She’s in trismus.”

“Oh damn.”

I grab the leg and it’s stiff. To no one’s surprise, asystole is present on the monitor.

We were too late.

Needless to say we called it. Of course I knew that there was absolutely nothing we or anyone else could do for her but I still hated it. I kept my emotions together, though, and called for the coroner. I got out of the truck and mom is standing right outside.

“Is she going to be OK?”

“Ma’am, I’m sorry to tell you…”

Mom lost it. I almost lost it. I’ve seen lots of dead adults but I had never had to call a baby. However, I kept my wits about me and went about gathering information, looking at the crib, asking about history, etc. The M.E. arrived and asked us to transport the baby to the county morgue. The whole way over I don’t say much besides checking on the welfare of my partner and our student. We all said we were OK but I know that we probably just don’t know what to say in the moment. A part of me was honestly glad that I don’t have any kids because I could only imagine how much worse this call would be on me.

As it was, I just wanted to go home.

When we arrived back at base no one said a word to me for a while other than asking me if I was alright, etc. I finished my report, ran a couple more emergency calls, caught a long distance transfer and didn’t run another call after we went to bed (and for that I was grateful). When I went home I took an extra long nap because my night on shift was spent mostly tossing, turning and thinking too much. By the next day I was better but I still hated what happened.

This was a first in my career. I’d love to never work another one of those calls again but I know that there’s no way to guarantee that I’ll never get that call again. I talked some of my EMS friends and they all agreed that this is a call that no one in EMS ever wants to get but one that we must learn to handle. Most I’ve talked to have told me that you never completely get over a call like that. I fully understand why.

The day I stop being affected by something like this is the day I rip the patch off my shirt and do something else.

I’ve pressed on but I still think about it sometimes. To see what the family went through when we had to tell them that their precious baby was dead left a mark on me that will never completely go away. This is one of those call in EMS that never gets easy, at least it shouldn’t. I was able to learn from this experience so I suppose I can say that nugget of good came out of it.

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Medic Musings near Christmas

December 18, 2011 By 1 Comment

Hello strangers! For the two of you who wondered if I’m still alive, I promise that I am. I’ve been staying pretty busy with work and some personal things that have been going on. I’m not going to promise that things have completely calmed down but they’re starting to.

I’m in the process of making some changes in my career.

Recently I put in my notice at my current full time job. I’ve really liked working there and I’m planning to stay part time. The place I’m taking a job at is actually my current part time job. This will mean better pay, better benefits (including state retirement) and a better schedule. I had to take it when they offered the position. I’m really looking forward to it and I think this will be a positive change all around for me and my family. I’ll sure miss my co-workers at my current job, though, and I’m glad that I’ll still get to see them sometimes.

Over the last few weeks I’ve learned more and more how important it is to have a “wind down” ritual when I come home from a shift. At least for a little longer, I mostly work 48 hour shifts (at my new job I’ll work 24 hours at a time) and I’ve found that it takes a while for me to unwind after a shift. I’ve discovered the secret, at least what works for me: I watch some cartoons and take a nap. While some might say I’m just trying to grasp on to what’s left of my childhood, I see nothing wrong with doing something comforting after a long shift. Apparently I’m not alone in that. @LizzieTheMedic tweeted via Twitter that her post-shift ritual involves some food and a nap. @WalterWelle tweeted that he likes to drive his own vehicle after a shift (something I also enjoy). I’ve heard of a medic who even likes to knit after a shift. One thing I can say without a doubt is that we all need a release. I’m trying to find other outlets for my days off as well. If you just come home and do nothing to relieve stress, you’re doing yourself a disservice. We all need something to calm us down and keep us sane.

Finally, I want to wish each and every one of you a merry Christmas. I know that this time of year is tough for many people, as we all face the possibility of having to spend yet another holiday away from our friends and family, not to mention the things we may encounter on the job. I’m blessed in that for the first time in several years I’m off this Christmas; if you’re not so fortunate, just remember that you’re not alone. Who knows, you might actually help to make someone else’s Christmas a little better in some way. While your family may not fully understand and like the fact that you have to spend yet another Christmas with your work family, a patient may be very grateful that you’re there Just remember that we you go about the rest of the year. Even if you’re not a Christian or otherwise celebrate Christmas take a moment to think about how you can show great love to someone else.

Here’s what Christmas means to me;

 9 An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. 10 But the angel said to them, “Do not be afraid. I bring you good news that will cause great joy for all the people. 11 Today in the town of David a Savior has been born to you; he is the Messiah, the Lord. 12 This will be a sign to you: You will find a baby wrapped in cloths and lying in a manger.” 13 Suddenly a great company of the heavenly host appeared with the angel, praising God and saying, 14 “Glory to God in the highest heaven, and on earth peace to those on whom his favor rests.” Luke 2:9-14 (NIV)

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To the OWS Protesters:

November 16, 2011 By Leave a Comment

Dear OWS Protesters:

First, I want to commend you for having the guts to “take on the man.” Your voices have been heard and you’ve made your points. I say “voices” and “points” because those were many. Since you have had no unified goals or leadership it’s been difficult to tell just what you were trying to accomplish at times. Again, congratulations on having the courage to take a risk and protest.

Having said that…

You have worn out your welcome. While you’ve been touting how you’ve been keeping the parks and other such public places where you have been occupying clean, you’ve kept others from enjoying the public places you’ve taken over. Not only that but some of your brethren in other cities have taken to assaulting police officers and one of your ilk in New York assaulted a member of the NYC EMS (Social Medic covered that here). We get it: You’re angry because you spent student loan money getting a Masters degree in underwater basket weaving and now can’t find a job making $100,000 per year.

Here’s a reality check: I took out student loans to become a paramedic. I’m still paying those off and will be for at least a few more years. I also don’t make nearly $100,000 per year. I work a full time job, have a part time job and I’m also a volunteer when I have the time. Why should you get anything handed to you when you don’t seem to want to work for it? Some of you have said you want a check at a “living wage” regardless of employment status I resent that. Why should I have to work for you to sit on your tail so you can surf Twitter all day, lamenting that your latte from Starbucks was made incorrectly?

I pay for enough people who don’t need public assistance yet get it anyway as it is. Don’t add to my problems.

You say you hate big business, yet you have no problems using your iPhones, Blackberrys and Android phones to shout your views. You do realize that all of that money went to a corporation, right? Whichever cell provider whose 3G or 4G you used is also a big corporation. The fast food you ate, yes even the Starbucks? All of the money you spent goes to a corporation. All you did during these protest was line pockets of the companies you seem to despise. You know what they’re doing?

Laughing all the way to the bank.

The success or failure of your mission will be the topic of debate in the coming weeks. If my opinion matters, I say you failed, mainly from a lack of vision, leadership, unification and hypocrisy. I will be glad to see you go. Yes, you have the right to assemble. Go ahead and do it again, it’s your right. However, you don’t have the right to clog our streets and otherwise disrupt our lives. You also don’t have the right to assault police officers and paramedics.

If you really want to make a difference, make something of yourselves. Stop blaming everyone else for your bad decisions and laziness.

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Religious Experiences

November 12, 2011 By Leave a Comment

During my last shift, I had a first in my EMS career and one that I really hadn’t expected. My partner Mike and I were dispatched to one of the downtown churches for an unresponsive patient, unknown if patient was breathing.

As we rolled up on scene, we noticed several people out front doing the “ambulance dance” (you know, waving wildly, jumping up and down and otherwise looking like we’re all in a big game of Whack-A-Mole) and telling us to hurry. I tell Mike to go ahead and bring the stretcher in because I knew that given the setting it would likely be in our best interest to scoop and run.

As I entered the sanctuary I immediately noticed that the patient is, indeed, the pastor. I could  hardly hear myself think from all of the people shouting, praying for their beloved pastor. I tried very hard to be respectful and tactful but I had to ask the ones who were around him and praying over him to move. Thankfully they understood and cleared a path for me as Mike brought the stretcher in behind me.

It turns out the good pastor was no longer unresponsive, in fact he seemed very full of the holy ghost if you ask me!

By the time it was all said and done, the patient stated he was speaking and became weak. As he was helped to the ground he said he “went blank” for a few seconds but otherwise he was just weak. Vitals were all normal, the monitor showed sinus tach with no ecotopy  and the CBG was well within normal limits. A fluid bolus seemed to help the pastor feel better.

All the while, he was thanking God for my partner and I. In my mind I hadn’t done anything worthy of praise, unless I should receive praise for simply doing my job (and for the record, I don’t think that deserves special recognition) but he was certainly thankful. During the transport I revealed to him that I am also a Christian. This only seemed to help our relationship.

At the ER I was able to check on him after I finished my report. I was greeted by an enthusiastic “my brother!” as I entered the room and he reached out to shake my hand. Thankfully he was fine, save being about a liter low on hydration. A couple of his family members hugged me and thanked me for all of my help.

This was one of those rare good calls that reminded me of why I got into EMS.

I used the word “relationship” intentionally a couple of lines ago because that’s what we should always seek to do in my opinion. We always hear how we should treat our patient as a person but rarely do we think about creating an actual provider-patient relationship as opposed to an acquaintanceship. In my mind this is part of being a good paramedic and providing good customer service (yes, we should always strive for good customer service even in EMS, however that’s another post for another time). It was a good reminder of being a good facilitator of customer service.

By the way, thanks to everyone who has read the “Internal Battles” post where I revealed my battles with anxiety and depression. I was overwhelmed by all of the comments, emails and tweets I received about it. It’s so good to know that I’m not the only one in EMS who has ever had to face this. It’s always nice to be reminded that I’m not alone.

It turns out that none of us are. Ever.

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