An Open Letter to EMS “Bros”

Dear Males of EMS:

I would like to remind all of you that the year we are in as of the date this is being written is 2017. A lot has changed in the last 30 years or so. Hell, a lot has changed in the last decade. Maybe you’re one of the guys who decided they wanted to join up and be a paramedic or EMT after watching “Mother, Jugs, and Speed” once too many. There may have been a day when one could be counted as socially hip if they routinely referred to their female partners and coworkers as “sweetie,” “little lady” or other pet names that one might think sound so cute and sweet. Maybe even today you think it’s perfectly alright talk down to the women of EMS and explain the ways of the emergency service world because these ladies couldn’t possibly understand this man world. And when someone calls you out on this crap, you try to say “Oh, I was just kidding!” Well, here’s what I want to say to you:

Shut the fuck up and respect these women.

Were you raised in a barn? Did you somehow not evolve from Neanderthals who used to find a wife by hitting her with a club and dragging her to the cave to have his way with her? I know your mother raised you better than that. I have to wonder, how would she feel to know that her son was such a moron and thought so badly about women that he thinks he has to be the big, bad, man who tells the little lady who wants to play medic how it is?

Or, maybe the problem is the lack of endowment between your legs.

I have had the pleasure of working with women who have run circles around me. I have worked with women who are much more knowledgeable about medicine and patient care than you will ever be. I have seen women get the hardest tubes, the toughest IVs and lift that bariatric patient that you had to call for a second rig for.

And sorry to disappoint you but most women in EMS are not badge bunnies who want to have sex with you (doubtful they would have sex with you anyway).

Treat women with respect. Period. If you can’t do that, get out of EMS because you are a large reason why EMS is looked up as the redheaded stepchild of emergency services and healthcare. You are what makes us look like a bunch of cavemen with the IQ of Forrest Gump.

Would you want your sister or your daughter treated the way you treat your female co-workers? If not, then don’t do it yourself.

Grow up. The station is not your frat house.

With Love,
Medic 51, NRP (Ret.)

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Intubation Is Overrated

One shift I was called out to a code and when I arrived I decided to work it. This was back in the days of the “scoop and run” method of resuscitation so we were trying not to spend much time on scene. When it came time to try and drop a tube, the patient’s anatomy and other factors were working against me. After three attempts, I dropped in a CombiTube and began to ventilate. As I checked placement, I thought, “Huh. This is moving some good air. Let’s roll with it.” I had a firefighter riding with me so I was able to take a moment to do a proper radio report en route, which included the fact that I was unable to intubate the patient and had dropped a Combi. When we arrived, the doctor was ready to pull out the CombiTube and drop an ET tube but noted that air movement was more than adequate so it was left in while they continued to work on the patient.

From then on, I made it a practice to use a CombiTube over an ET tube. Among the reasons for this was that the CombiTube was much quicker and almost always successful without having to manipulate the patient’s neck and jaw in unnatural ways. If I was in a controlled environment, I could drop tubes all day every day but in an ambulance with little room to work, this is usually a different story (and if we are honest with ourselves, this is more often the case than not). Intubation is an art, one that is very easy to mess up for a variety of reasons.

One of the dogmas of EMS is that intubation is an essential skill and without it, there is not much use in being a paramedic. Such dogmatic devotion to skills is largely what has held EMS back as a profession almost from its inception. The reality is, as a group, paramedics stink at intubation. Let’s keep in mind that intubation was never intended to be practiced in the back of a cramped moving vehicle and that the method by which a patient is intubated does not lend itself well to an ambulance. Even medics who are good at intubation often run into difficulty dropping tubes in such conditions.

It’s time to let it go.

There has been a big blow up about intubation possibly being removed from the National Scope of Practice model. I really hate to tell those who are crying foul over this that research does not support their position. As mentioned above, EMS as a group stinks at intubation. Multiple studies have also shown that other methods of airway management (even something as simple as an OPA) can provide the ventilation necessary for out of hospital management of cardiac arrest. In the AHA algorithms, airway management is way down the list in favor of quality CPR and defibrilation.

I’m offended by much in this situation but mainly I’m offended at providers whose egos are so fragile that they feel the need to engage in fear mongering (“this is about saving lives!”!) and threatening to leave the field if they can’t intubation (if that’s how you feel, then please do see yourself to the exit). Paramedics have the audacity to make these claims while engaging in a medical field that has some of the lowest educational and entrance requirements of any branch of medicine. We have the audacity to demand the right(!) to drop tubes, administer medications, and perform procedures with no real education on what these treatments truly mean to a patient.

EMS needs to let go of the hero/victim mentality.

I stand as an advocate for EMS even though I chose to leave the field some time ago. I will fight, I will advocate, I will encourage those who practice paramedicine to be the best they can be. But, I do not stand with my brothers and sisters on this issue, not when we are simply not good at this skill and when there are much more efficient options for airway management which provide quality ventilation. If we truly want to have the means to give our patients the best care that we can possibly provide, we need to check our egos at the door and be willing to allow skills that do not benefit patients to be placed to the side.

Anything short of that, we are not in it for the patients. We are only in it for us.

Let’s Not Make a Martyr Out of an Idiot

Earlier today I was saddened to hear the news of a Dallas Fire-EMS paramedic being shot in the line of duty while attending to a patient. But after watching the news conference where city officials gave an update on the condition of the medic and the patient (both are stable as of this moment), I’m still sad but I also found myself going, “what an idiot.”

There is controversy about what was contained in the dispatch notes (the shooting was possibly coded as a self-inflicted wound) but this does not negate the fact that the crew still went into a shooting scene without police presence (a reporter asked if police were on the scene when EMS arrived and the answer was “no”). I’m not stupid. I know that no scene is absolutely safe but if you go into a situation that you know is dangerous and you have no protection whatsoever, you’re kind of asking for trouble. I really hate that the medic was shot and I hope and pray that he has a full recovery. But, he really needs to brush up on his fundamentals if he wants to have a longer career on the box.

Put down your pitchforks and torches, you will get nowhere with me. I won’t change my mind.

There have been the usual calls for arming EMS providers and for giving them body armor. Oh, please. Stop that stupid bullshit. EMS has no business looking any more like cops than they already do. Try going into a rough neighborhood where grandma is having a heart attack. Let me know how well it goes when you walk into her house wearing a tactical vest and a sidearm. Let me know about the suspicious looks you get or about the threats you receive (overt and otherwise). Tell me about the shooting calls you respond to where the patient won’t give you any kind of information about the incident because “you look like a fuckin’ cop.”

And let’s not kid ourselves. We all know people in EMS who are the last people on the planet that need anything to make them feel like they have any kind of authority. These are the kind of people that if they were to start looking more like the police, they would start acting more like the police than they already do (newsflash: No EMS provider has any kind of authority so stop thinking you have any right to order people around). I know one in particular who is a former military guy. While I am grateful that he served this country, he has the mental capacity of a grapefruit (he’s the stereotypical idiot grunt) and has no business carrying a weapon in public.

The answer is not to arm or military-up EMS and we damn sure should not be making some idiots who entered a scene where they knew there was a likely threat and had no protection into heroes. Such stupidity does not make them heroes, it makes them a liability because then they are no good to the patient or anyone else. In other words, all they did was create more problems for their colleagues and for the Dallas PD. That’s not bravery, that’s stupidity.

EMS just needs to start using its damn common sense and stop trying to be Billy Badass.

RANT: Standard of Care

When I became an EMT, I quickly realized that EMS could be more than it currently is. So, I became an advocate for and supporter of increased increased education. I believe in evidence-based medicine in EMS. If EMTs and paramedics are ever to be recognized as real medical providers rather than getting the proverbial pat on the head by nurses and doctors, more education and acceptance of evidence must be embraced and utilized.

In other words, I’m an advocate for the advancement of EMS.

Even though I’m retired from being an active paramedic, I’m still part of a few EMS groups on social media. A discussion ensued about the Philadelphia Police Department’s “scoop and run” policy. If you’re not familiar, essentially anyone with penetrating trauma within the metro of Philly, PA gets a ride to the trauma center courtesy of a police officer. My understanding of the policy is that this is regardless of the availability or proximity of EMS.

Let me put this into perspective: A police officer who is likely not trained as an EMT, nor equipped to provide anything besides very basic first aid, throws a gunshot or stabbing victim into the back of his car and hauls ass to the hospital.

Now, you might be saying: “But Medic, if someone has penetrating trauma they don’t need a ‘medic, they need a surgeon and a blood transfusion.” You would be correct: Definitive treatment is definitely those things but that patient may have immediate life threats that can not be managed by a medically untrained police officer and instead would require a medic. The first thing that comes to mind is airway management. Can a cop suction an airway, place an appropriate airway (NPA, OPA, ET Tube, or whatever may be indicated), and ventilate a patient? No. All the cop has is a lead foot and prayer.

So I chimed in and indicated my concerns and disagreement with such a policy. Several disagreed with me and cited studies to back up their claims. As an advocate for education and evidence in EMS practice, I support studies but I do not support non-medically trained public safety officials transporting patients who are on the edge of death simply because it’s always been done that way.

I acknowledge what the studies say but I still do not support such policies from an ethical and moral standpoint. I was accused of not being a true patient advocate or of having my ego bruised. No. It’s because of the fact that I am a patient advocate that I believe police transport of injured persons is a crock of bullshit.

First and foremost: A patient’s family member is not going to give one single fuck about what a study says if their loved one dies as the result of aspiration or of otherwise having a compromised airway.

Also, ponder the following (all of this assumes we’re talking about a medically untrained police officer without proper equipment):

Can a police officer do a rapid trauma assessment and control serious external bleeding?
Can a police officer manage an airway?
Can a police officer provide bandaging and any needed splinting?
Can a police officer initiate IV access so that a patient can more quickly receive blood?
Can a police officer provide pain management of any sort?

Can a police officer do all of this by himself while he is driving?

And perhaps most importantly: Can the officer properly restrain the patient who will be lying in the backseat of his car in order to prevent worsening of the patient’s trauma and to otherwise keep the patient from being thrown around like a rag doll?

The answer to all of this is “no.”

Fuck the studies in this case. They don’t take into account that the patients are literally thrown into the back seat of a car, unrestrained, and sped off to a hospital by a police officer who likely has no medical training beyond the department-mandated Red Cross First Aid card and is weaving in and out of traffic and, as mentioned above, throwing the patient around the backseat with no restraint. They also don’t take into account that the patient is treated as a sack of potatoes rather than as a person.

It’s unbelievable that in 2017 we still have a major city giving 1960s-level of patient care.

EMS has come a long way since its inception. We have a much higher standard of care for trauma patients that has little emphasis on “scoop and run” and an emphasis on actually beginning treatment of the patient. Police officers simply are not trained or equipped to provide this standard of care.

I’ve not been able to find out if any lawsuits have resulted from this “scoop and run” policy but I would be willing to bet that if someone died as a result of lack of proper care or as the result of being improperly transported, a jury would not be too kind to the City of Philadelphia or to that unfortunate police officer who is on the receiving end of that lawsuit.

Police officers do many wonderful and amazing things and I am grateful for what they do. However, in my experience, most cops would agree that playing EMT is not something they want to do or should do.

Let the cops be cops and leave the medical treatment to those with the education to do it properly.

/rant