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How do I become one of the “experts”?

October 24, 2011 By 1 Comment

http://www.jems.com/article/news/expert-chin-lift-restore-breathing-would

I would tell you to go read the whole article, but the first paragraph pretty much contains everything you need to see…..

“Michael Jackson died because Dr. Conrad Murray failed to notice that his patient had stopped breathing while he was hooked up to an IV drip of the surgical anesthetic propofol, an expert anesthesiologist testified Thursday.”

Yea, you read that right. It wasn’t the fact that he was administering A FREAKING SURGICAL ANESTHETIC to help MJ go to sleep, he just failed to notice that he wasn’t breathing. Hell, he could have just shot him. Then maybe the “experts” could testify that he died because Dr. Murray failed to control his bleeding.

“Dr. Steven Shafer, probably the last witness before the prosecution rests in Dr. Murray’s involuntary manslaughter trial, said Murray should have realized Jackson had stopped breathing about 11:45 a.m. on June 25, 2009.”

***beating head on desk***

No, Dr. Shafer, he shouldn’t have been administering the wrong drug for the wrong reason. Remember the 5 rights of drug administration that we learned in school? I’m going to go out on a limb here and say that Propofol is probably not the right drug to administer for someone that can’t sleep. But then again, I’m just a dumbass paramedic.

The rest of the article is essentially pointless. Anybody that’s worked anywhere near an ER, OR or ICU can tell you that heavy sedatives…..well, sedate people. So they needed an expert to say that his airway was compromised? Where do I sign up to testify? Seriously, fly me out to California. I can easily get up on the stand and say something that sounds smart. I would say something like “My training and expertise tells me that he died from cardiac arrest. His life could have been saved if CPR was started sooner”.

The only thing that matters in this case, is that Dr. Murray was administering a dangerous medication in an uncontrolled environment. I don’t care that he “wasn’t properly monitoring his patient” or “didn’t perform a basic airway maneuver”. None of that would have been an issue had no chose to give the sedative in someones house.

In the end, it doesn’t really matter. Micheal Jackson would have found some doctor willing to go against everything in his training in exchange for large sums of money. Sooner or later this was bound to happen, whether it be Dr. Murray or some other cheese-dick doctor.

I am serious about the “expert” witness thing though…..how I become one of those?


Filed Under: Featured, Opinion Tagged With: , ,

It’s all about the provider

October 10, 2011 By Leave a Comment

I have spent the overwhelming majority of my career working in the private, for-profit sector of healthcare. I got my feet wet working at a radiology clinic while I went to EMT school at night. I worked there for about 2 years before I finally landed my first EMS job at a very small “mom-and-pop” ambulance service about an hour north of town. I worked there part-time and stayed full-time at the radiology-clinic for about 2 years before landing a full-time job at the large metropolitan ambulance service. Nearly 7 years later I parted ways with that job and am now working at a non-profit children’s hospital and a small, rural, non-profit ambulance service.

Many things have changed throughout my journey. My work setting has changed dramatically several times, but what has remained consistent is me. Sure, I have certainly grown and matured throughout my career, but my work ethic, professionalism and level of care has pretty much stayed the same.

In every setting I have seen exceptional care-givers and I have seen exceptionally bad care-givers. Every place I worked at had their strengths and weaknesses. Sometimes I agreed with their practices, and other times I didn’t. Over the years I have developed an opinion on what I feel is the “best” way to run an EMS system, and I know that there are plenty of people out there that disagree and most likely have equal – if not better – ideas than I do. I know that I’m never going to be 100% right, and neither will anyone else. What remains the same, is that we both care enough about the profession to share ideas and try to improve the industry.

One thing that has really stuck with me, was something my boss said to me before leaving my job at the metropolitan ambulance service: “No matter where you end up, don’t ever lower your standards”. I didn’t fully grasp what he was saying until I started both of my new jobs recently. During classroom orientation at the hospital, I quickly learned that the management practices are much different than what I’m used to. Not in a good or bad way, just different. Once I got onto the floor and started training, the human factor set in. Both places offer plenty of training resources, good protocols, and top-of-the-line equipment. And just like both places, there are those who choose to take advantage of it, and those that don’t. Most people care about the quality of care that they provide, but unfortunately, some people just do enough to stay out of trouble and bring home a check.

Now let’s look at the other side of the coin. The small, rural ambulance service I work for reminds me a lot of my first EMS job. Both companies don’t have the resources of the large hospitals or the metropolitan EMS systems. They may not have bleeding-edge technology, but their equipment is good, functions well and serves it’s purpose when caring for patients. Most of the EMT’s and Paramedics working on the trucks (a new term I picked up working out here in Texas) use the long transport times and limited resources as an opportunity to improve their skills and actually do some real hands-on patient care. And of course, there are the few that choose to use the setting as an excuse for “not being able to do their job”. Once again, completely different settings, essentially the same people working.

I guess where I’m going with this, is that it doesn’t matter what setting you work in. Whether it be fire-based, private-based, non-profit, 3rd-service, or volunteer, the decision to provide quality patient care is up to you.

Good patient care isn’t measured by your protocols or resources. It’s measured by compassion, competence, and the willingness to do what’s right for the patient. It doesn’t matter if you show up in a brand-new ambulance with all the latest equipment and aggressive protocols, or if your on the side of the road in your private vehicle with nothing but a first-aid kit. You can still provide quality care to the best of your abilities.

So, back to the previous statement about “not lowering your standards”. It doesn’t matter what system you work in, the decision to provide quality care is yours. Just because a service doesn’t require you to attend airway training doesn’t mean you shouldn’t practice on a dummy frequently. Your service might be very conservative on the amount of medications and procedures that are allowed in your protocols, but that doesn’t mean you can’t do a thorough assessment and treat your patients to the best of your ability. The same goes for appearance. You should always present yourself in a professional manner, regardless of the mandatory dress code or lack thereof. You may be able to get away with wearing a worn-out, faded uniform – hell, it may be all that’s available to you – but that shouldn’t stop you from ironing it every day and at least looking like you give a damn about your job.

If there is one thing that I have learned throughout my years in healthcare, it’s that management simply cannot force good or bad patient care. They can certainly influence it one way or the other, but the final decision rests with the provider on the ground.


Filed Under: Featured, Opinion Tagged With: , , , , ,

Who needs experts when you have lawyers?

September 27, 2011 By 2 Comments

Illinois Boy Dies in Ambulance during Hospital Transfers

Seven-year-old Aaron Pointer spoke his last words from the back of an ambulance.

“I . . . am . . . tired . . . of . . . breathing,” the asthmatic boy gasped, taking breaths between each word, according to a nurse’s report.

This is certainly a tragic story, and a terrible way to do die. It’s also a very important lesson for us EMS folks that regularly do inter-facility transfers. Incidents like this are why it’s important to determine if a patient is stable for transport and stand your ground if you don’t feel comfortable. While I don’t know any details outside of the media’s report (and you know how much I trust the media), I do know a situation like this would have probably required a specialized transport team, or better yet, air transport. This is of course assuming that said resources were available at the time. Once again, information that the media fails to provide.

When investigating cases like this, we always have the luxury of spending all the time we need to gather the facts and determine if the treatment was appropriate. It’s an unfair advantage that lawyers and administrative folks have, but that’s life. And that’s why we do the job that we do. We train to be able to make these decisions within minutes, if not seconds. Unfortunately, like this article points out, things don’t always go the way we want them to and we find ourselves in this position.

By no means am I criticizing the work of the paramedics on this call. I have been there, and I would be lying if I told you that I have never taken a chance with transports like this. Sometimes your only choices are to take the patient, or let them die at the facility they are at. It’s a bad position that none of us want to be in. As the article mentioned, the hospitals both transported the patient out because the treatment they had available wasn’t enough for his condition. I think the real questions we need to ask are: Why 3 hospitals? Did the kid present better at the first hospital, not necessarily raising any flags that warranted a 45-minute trip? Was there a specialty transport team available? What interventions did the hospitals and EMS attempt before the kid deteriorated?

Like I said before, it’s important to evaluate these cases carefully before initiating long transports. In a situation where the hospital simply can’t provide the treatment the patient needs, then “standing your ground” might mean to demand that a nurse or RT accompany you. If the patient is that bad, talk to the doctor about placing an advanced airway prior to leaving the hospital. These are all things that might have have been done, but we will probably never know for sure.

“Intubating a 7-year-old is difficult in the best of circumstances, much less in an ambulance,” during a long ride, said the family’s lawyer, Joseph Miroballi. “It’s a disaster waiting to happen. It’s a formula for death.”

This is where I typically start getting irritated when reading stories like this. Lawyers acting as medical experts. If intubating a 7-year-old is really “difficult at best”, then I must be the king of pediatric airways. Then again, a lawyer attempting to intubate a child WOULD be very difficult, so maybe his statement had some truth to it.

“They send him even though he’s not stable,” he said. “Why they didn’t put a doctor in that ambulance with him, or an anesthesioloist or someone who would manage his condition during that long transfer, we don’t know.”

I don’t even know where to begin with this one. Has anyone ever had a doctor, much less, an anestesiologist ride in with you during a transport? Yes, it sounds like the level of care available on the ambulance wasn’t sufficient, but sometimes I think the expectations placed on us are a bit unreasonable. Many ER’s, especially rural ones, only have 1 physician. So what do we do? Close down the ER so the doc can ride in?

There are so many factors not addressed in this story that it’s pretty much impossible to determine if anyone really did anything wrong. But hey, why let facts get in the way of a good story?


Filed Under: Featured, News, Opinion Tagged With: ,

I’ll never forget

September 11, 2011 By Leave a Comment

I still remember the morning of September 11th, 2001 like it was yesterday. I woke up early that morning and walked into the living room to find my parents watching the news on TV. My mom told me that a plane had struck one of the World Trade Center towers. Of course, I just assumed it was a commercial flight gone bad. It didn’t even cross my mind that such a thing could have possibly been done on purpose. I continued on with my normal morning routine, just as I would have any other day. That is until I heard the reporter on the TV report that the second tower was just hit by another airline.

My heart sank.

I had never felt such a terrible feeling in my stomach. At that point I knew America was under attack. All that bad terrorist stuff that I heard about happening in other countries was now happening in my home. I didn’t want to go to school. Hell, I didn’t want to go outside. I wondered who the hell could have done this, and how long it would take for us to deliver justice. I wanted to do something, anything.

I walked into my first-period Government / Econ class and saw the news on the classroom TV. Our teacher told us to sit down and be quiet as we all walked in the door. Once we all got situated in our seats, he told us “you all sit down and watch this closely and NEVER forget what’s happening right now”. He said that once the shock wears off, debates and finger pointing will ensue and the only thing that matters is that we are now at war. He didn’t say another word for the entire class. We all sat there and watched the reports of the Pentagon being struck and the plane going down in Pennsylvania. It was a terrible feeling just sitting there wondering who was next.

The bell rang for us to move on to our next class. We reluctantly got up and started to walk to our designated classrooms. During the 5 minutes that we had to walk to our 2nd period class, the principal’s voice came over the intercom and instructed us to stop where we were and turn and salute the flag at the east side of the campus. He then proceeded to lead us all in something I hadn’t done in a public school since the 6th grade. The flag salute. I remember a chill running down my spine as every student and staff member stood outside and recited the pledge of allegiance.

The rest of the day was more of the same. Every classroom had the news going on the TV and our usual assignments were put off until the next day. We continued to do the flag salute for a couple of weeks and it eventually died off. People were back to their daily routines. The airlines were flying again, and it was business as usual. One thing was different though. For the first time in my life, I truly felt that we were all united as Americans. It’s as if party lines didn’t exist. People were making donations, giving blood, waving flags, etc. At that point I knew that nobody could ever take us down. We were Americans, dammit, and nobody was going to come into our home and push us around without some serious consequences.

It didn’t take long before we started fighting amongst ourselves. People started playing the blame game and pointing fingers. Rather than going after the people who did this to us, we were searching for a scape-goat from within. Why? What happened to the America that we were right after the attacks? Did everyone already forget that we are in this together?

This song pretty much sums up how I feel:

I haven’t forgotten and I never will.


Filed Under: Featured, Opinion

Since when is it not our responsibility?

July 29, 2011 By 17 Comments

http://www.ems1.com/ems-management/articles/1085828-Texas-medics-stop-treatment-after-reading-patients-will/

 SAN ANTONIO — It was a life or death situation. Paramedics responded to an emergency call on the east side. And while they initially started working on the man, they stopped after reading his will.

I’m actually surprised this kind of thing doesn’t make news headlines more often. I have encountered this type of scenario several times throughout my years in EMS. It’s not uncommon for family members of dying patients to be unaware of their loved one’s wishes or to just flat out change their minds when the time comes. It’s a tough situation for everyone when the family’s request contradicts the patient’s wishes. I don’t think the paramedics did the wrong thing in this scenario, but I probably would have handled it a little differently. More on that in a follow-up post.

Losing a loved one is never easy. But Terry Read says his father, Samuel, might have made it if paramedics had just kept working on him. Since that day, he’s been fighting to make sure this never happens to another family.

I agree that it’s never easy losing a loved one, but did any of the patient’s family members stop to think about what he wanted? That is why people write living wills and sign DNR orders. It is the only way that they can be sure that their wishes are honored once they are unable to make decisions for themselves.

 ”EMS personnel do not have the responsibility or the training or the knowledge to interpret legal documents,” Representative McClendon told us.

If that’s the case, then why even have DNR orders? That is one of the most ridiculous statements that I have ever heard. She is right about one thing though; we certainly don’t have enough training on legal issues. Acting in the patient’s best interest is absolutely our responsibility, and sometimes that includes not acting at all. In this case, the patient made it clear that he didn’t want his life to be prolonged and the paramedics on scene simply honored his wishes. Could they have gone about it a better way? Sure, but that doesn’t change the fact that they did what the patient truly wanted.

“Emergency responders, paramedics, are not in the business of interpreting living wills. They’re in the business of doing what they’re trained to do, which is to administer emergency medical treatment,” Terry Read explained.

I’m actually just stunned that somebody publicly acknowledged that we administer “emergency medical treatment” and don’t just “drive” the patients to the hospital. However, she’s wrong. Like all other medical professionals, we are patient advocates. Yes, proper treatment is our priority, but does that include treating somebody who doesn’t want to be treated? I wonder if she feels the same way about families that wan’t us to honor the DNR of their loved one? Are we to just ignore them and start pumping on some guys chest since we are too stupid to interpret legal documents?

I always hate running into situations like this, but it’s part of the job. It’s a lose-lose situation. If you just transport and ignore the document, you aren’t really representing the patient’s best interest and if you honor the document, you piss off the family. Ideally family members would sit down and talk with their loved-ones and doctors to come to an understanding of what they want when their life ends. But I guess if things worked the way we wanted them to, we probably wouldn’t have jobs.

Standby for a follow-up post on how I personally deal with these situations.


Filed Under: Featured, Opinion Tagged With: ,

But it was only a beer can!

July 18, 2011 By 4 Comments

http://www.bakersfield.com/news/local/x1206331925/Turmoil-remains-in-wake-of-shooting

Kern County Sheriff’s Department officials are investigating the circumstances surrounding the officer-involved shooting death of former NFL player David Lee “Deacon” Turner, 56 — a process that is being closely watched by members of Turner’s family, who are praying for justice.

It’s the same old story every time. Guy does something stupid like HIT A POLICE OFFICER IN THE HEAD with a bag filled with 24 ounce beer cans, and everybody is surprised when he winds up shot. The family comes out and cries foul play, the newspaper runs stories showing crying and distraught family members and the opinion section section is loaded with garbage like this:

I do not know David “Deacon” Turner or any of his relatives, but I was shocked and upset by the reported details of his death. Yes, Turner had a criminal record, but that does not justify any of this. Let’s see, two beer cans vs. a gun. If the police officer had used a stun gun, or his flashlight, or pepper spray, or a club, it would have achieved the desired effect. Those two beer cans might not have been considered “deadly weapons” and Turner might be alive today.

Really? You were shocked? Were you aware that the injured deputy was transported to the hospital by ambulance since he was hit hard enough that he was nearly incapacitated? Did it ever occur to you that if a deputy is knocked unconscious that his gun is now available for the suspect to grab and use against him? You are right about one thing though. A gun is certainly a better weapon than a beer can. But last time I checked, that’s why cops carry guns. They aren’t in the business to get into “fair fights”. That’s why unarmed people get tased, pepper sprayed, and hit with batons. Once you add any weapons into the equation, then all bets are off. If a deputy tries to fight someone with a weapon like a baseball bat, knife, and yes, a bag full of bear cans, then they are taking a risk. Nobody wants to take that risk, and they shouldn’t be expected to. If you don’t want to get shot, DON’T ASSAULT A POLICE OFFICER.

Leading men from the community spoke to the media outside Tri-Stone Missionary Baptist Church in central Bakersfield Sunday and demanded answers to the questions about Turner’s death — why a man carrying only a bag with two beer cans in it posed a large enough threat that the only response for a deputy was to pull a gun and fire twice.

http://www.bakersfield.com/news/local/x1206332276/Community-calls-for-answers-in-Turner-shooting

How about asking yourselves why this “outstanding citizen” felt that the “only response” to a deputy trying to question him was to hit him in the head? Where is the outcry for the citizens of this community to start using common sense?

It’s easy for people to question a case like this when they have never been hit in the head by a can filled with liquid. Water doesn’t compress, and therefore a metal can filled with liquid is essentially a rock. It would be easy to go unconscious after being in the head by a single beer can, let alone 2 24-ounce beer cans. In cases like this, it doesn’t matter if you are swinging a baseball bat, hammer, or bag of cans. IF YOU HIT AN OFFICER IN THE HEAD WITH A SOLID OBJECT, YOU WILL BE SHOT. They aren’t going to try and fight fair or preserve your life. They will eliminate the threat.

The deputy that was hit is lucky that he had a second deputy with him. Had he have been alone, this would have gone in a much worse direction.

 

 


Filed Under: Featured, Opinion

Hey, that’s a great idea!

July 14, 2011 By 3 Comments

http://www.bakersfield.com/news/local/x965388605/Council-reviews-fines-for-false-burglar-alarms-keeps-redevelopment-agency

Under the proposed rule, alarm users would pay a fee (cost for police response) and a penalty for having multiple false alarms. On the first false alarm, users would get a written warning, but would be charged no fee for police response costs. On the second false alarm, a $105 fee would be imposed. That fine, however, could be avoided by completing “alarm school.” On the third false alarm, a $105 police response fee would be imposed, and also a $105 penalty. By the fifth false alarm, the total charge would reach $420, and it’s possible police won’t respond to the alarm.

At least the cops got it figured out. Now lets do the same for people who habitually call 911 for non-emergencies that result in a code-3 ambulance and fire response. The first time they get a “warning” – or coaching, if you will – on the proper usage of the 911 system. After that, we start slapping fines. If that doesn’t stop the person, then we will just re-consider even responding unless they aren’t breathing.

Now for those of you that think I’m heartless or a “barbarian”, I’m not talking about the 80-year-old grandma with chronic health issues. I’m talking about the town drunk who calls when they decide it’s time to get a change of clothes, a hot meal, and a place to sleep. Don’t think we could collect those fines? Sure we can. Just deduct it from their welfare check. Don’t collect welfare? Well then we will just quit transporting them unless they have a legitimate complaint.

I know this may sound outrageous, but unless we start making changes to the way we do things, these problems will never go away.


Filed Under: Featured, Opinion

Don’t make me get all religious on you…

May 26, 2011 By 3 Comments

Ok for those of you that know me or read my blog regularly, you probably know that I rarely talk about religion. For the most part, it is a touchy subject for many that I do not dare to bring up. For me, it’s a rather personal subject that I typically just keep to myself. I have my beliefs and I don’t try to pawn them off on anyone else. With that being said, there have been recent events that have drawn me into religious talks with many of my friends and family and I feel compelled to put some of my thoughts out here on the blog. So mark this day down on the calendar, because I’m actually going to talk some religion with you all.

If you were up late enough on May 20th, you may have seen me poking fun a the “rapture” that was scheduled to occur. My Facebook and Twitter updates were filled with all kinds of jokes and comments mocking all the hype. The part I found so entertaining was not the rapture itself, but the fact that people actually believed it was going to happen on May 21st. The even crazier part of the whole thing, was that all of the commotion was caused by one man making a prediction. Keep in mind, this same guy made the same prediction back in 1994 and was obviously wrong. Now most people probably didn’t believe him the first time around (at least if they were secure in their beliefs) and I would think that hardly anyone would believe him the second time. Unfortunately his following greatly increased in size this time around. I’ll give you a few reasons why I believe this happened, but first let me give you a little history on the subject.

Harold Camping is the president of Family Radio, a Christian radio station group. He has essentially made his name by predicting “Dooms Day”. He claims to know the exact date of the rapture due to evidence “hidden” within the bible. He published a book “1994?” which outlined his initial prediction that Judgement Day would occur in September of 1994. When that date came and went, Camping attributed his failed prediction to a “mathematical error” and later claimed that May 21st, 2011 was definitely the date of Judgement Day. When the 21st came and went, he then claimed that his predicted day was a “spiritual judgement” rather than a physical rapture. He now believes that the actual rapture will occur simultaneously with his predicted date of the worlds destruction on October 21st, 2011.

Regardless of how he tries to twist scripture with interpretations, he can’t get around the fact that the bible clearly states that nobody but God himself knows the date and time of the rapture. Harold Camping’s predictions not only contradict that statement, but also completely disregards the book the of Revelations. I’m no bible scholar, but I have read the book and I know that it was written in a way that everyone is supposed to understand.

People like Harold Camping attract a following by “interpreting” the bible in ways that make themselves appear to be smarter than everyone else. By doing this, they turn people to their own writings, rather than that of the actual bible itself. It’s as if their followers are dependent on an interpreter like Harold Camping to understand what the bible is saying. This kind of practice is manipulative and dangerous. Many people quit their jobs, donated all of their money and gave up their “worldly possessions” with the expectation that they would be taken to heaven on May 21st. Once the day came and went, they had nobody else to turn to but the person that led them through their mission of “saving” people. Now he tells them to keep up the fight because the world is going to end in a few months, and most of them will. Why not? They already walked away from everything they worked for. What do they have to lose?

The sad part of this whole thing, is that he will continue to change his story and drag these people along as long as he can. Unfortunately he will continue to make headlines, receive donations and gain popularity. He has his followers right where he wants them. If he actually believed what he was saying, then wouldn’t it make sense to do as he advised his followers to do and donate his millions to charity? His actions are no different than convincing people to eat poisonous pudding as a comet passes overhead.


Filed Under: Featured, Opinion Tagged With: , ,

It’s not supposed to make sense, it’s the government

May 12, 2011 By 6 Comments

The great state of California trusts me to carry and administer narcotics, drive commercial vehicles, raise children, and CARRY A CONCEALED FIREARM. But yet, when I buy a new pistol from the local gun shop, I STILL have to wait 10 days to pick it up. Why? Because I need a “cool down” period just in case I’m purchasing this firearm to intentionally harm someone with. Never mind the arsenal of weapons I already own – all of which the state knows about – and the fact that I entered and left the store with a loaded pistol under my waistband.

I can say that I feel Homer’s pain on this one:

 

Now on to the good news! In just 4 short days, I’ll be picking up this bad boy :)

I have always wanted a .22 pistol and I just never brought myself to get one. This Walther P22 looks promising. It’s comfortable, has a good reputation and has tons of accessories available. A range report will be available once I pick it up.


Filed Under: Featured, Opinion, Politics

It warms my heart….

April 27, 2011 By 1 Comment

….to see a community coming together like this to stop a group of protesters at a military funeral:

http://www.ihatethemedia.com/a-simple-way-to-stop-westboro-baptist-church-funeral-protesters

I’m all for the first-amendment, and I hate to say this, but I agree that these yahoos do have a “right” to protest. But just because it’s legal doesn’t mean it’s right. I have always been of the belief that if we governed ourselves better, we wouldn’t need a police force to handle all of our problems.

I guess in an ideal world, protesting would be without legal consequence, but it would come with a set of risks. Want to protest a funeral? Go for it, but don’t come crying to me when you get your ass beat by a group of pissed off family and friends.

Unfortunately that’s not the case. In todays society the instigators are protected and there isn’t a damn thing we can do about it.


Filed Under: Opinion, Random Stuff
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