Movies and TV have given society the impression that we see a bunch of really nasty, mangled and bloody patients, then just drive them to the hospital.  What they don’t see on TV is a paramedic talking to a grieving father after his 8-month-old child choked on a water balloon and is showing no signs of life. They don’t glamorize the mother of a little girl that was found beat up and left for dead in a trash pile, only to find out that her own husband was the one that tried to kill their daughter. When someone inquires about the “worst” thing I have ever seen, they usually aren’t expecting one of those answers. For the sake of not ruining casual conversation, I typically just tell some humorous story and keep those painful memories to myself.

When I started in EMS, death didn’t bother me like I thought it would. My first full-arrest was a rush. I was applying newly learned skills and doing something exciting. Most of my friends from high school were still smoking pot, partying, and enjoying life under the shade of the parental umbrella. Not me. I was pumping on chests, driving fast, and looking freaking awesome while I did it. I didn’t quite grasp the seriousness of the work I was doing. While I’m glad I started out when I did, I often wonder if I was mature enough to handle the job I signed up for. Fortunately for me, it wasn’t until sometime later that I truly experienced my first case where I got hit with the ole’ reality sledgehammer.

I’ll never forget the day I transported an elderly lady in full-arrest from a nursing home who was pronounced dead shortly after arrival at the ER. For me, this just another old person that died. I couldn’t even begin to count the amount of calls like this that I had run during my career. It was business as usual until I walked into the room of the now deceased patient to find a little girl crying by her side saying “I’ll miss you, Grandma”. It wasn’t the emotion from the family that bothered me, it was the guilt of not feeling anything. I wondered how I could have watched so many people die and never lost a night of sleep? Was I even human anymore? What was wrong with me?

I took a big look back on my career and couldn’t help but think about the all the times I ran a critical call, and went about my day like nothing happened. Hell, I even joked about some of these calls. The deeper I dug, the worse I felt. This was the start of many years of feeling guilt and questioning myself as a person.

For the longest time, I have felt that EMS has changed me as a person. I often question my morals, and at one point, I even questioned my faith. The things that bother me aren’t death or crippling injuries….it’s misuse of ambulance services, the entitlement mentality that many of our patients have, and the on-going joke called Medicaid reimbursement.

I often wonder if I’m so calloused as a person that something like the death of somebody’s loved one just doesn’t touch me. It’s not that I don’t care, I just don’t have any emotion invested in it. I know that as an EMS provider, I can’t be emotionally tied up in all my patients or their tragedies. If I was, I would be mess. We all would.

Now having said all that, I must clarify that I’m far from bullet-proof. I can go about my business of providing on-the-spot taxi services for those who refuse to care for themselves, pumping on grandma’s chest and doing my part to combat natural selection. That is, until I run into one of “those” calls that jump right out of nowhere and hit you right in the face. Like a young man in his early 20′s that was tragically killed in an unfortunate accident at work. Life is fine and dandy until I have to notify his father and inform him that his only son just died during a freak accident at a low-risk job.

So how do I handle that? I finish my PCR, help my partner finish cleaning the ambulance, and try to go about my day as I always do. I’ll eventually reach a quiet moment where the emotion from the event hits home. I think to myself that it could have easily been me or any one of my friends or family members. I put myself in the shoes of the grieving father and imagine how I would feel if I received that phone call. Then I take a look at myself and maybe even crack a little smile, because all the emotion I’m experiencing means that I’m still human. I remind myself of the reasons I do this job, then head out to start the cycle all over again.

What kind of Paramedic would Motorcop be?

First and foremost, guys like MC need a saying or a slogan. “Soul Crusher” just doesn’t seem fitting for a paramedic…..”Disease Crusher” however, does. Perhaps a patch featuring a picture of him stomping out disease and punching bacteria in the face would be appropriate.

I couldn’t imagine that MC would be happy working on an ambulance as it’s too big and too slow. I could see him working in a first-responder vehicle or perhaps even one of the lucky few that get to work EMS on a motorcycle. I couldn’t see him working 24 hour shifts, instead he would probably seek the traditional law enforcement schedule of 8-10 hours.

Instead of following a set of protocols, MC would set rules or guidelines for the body systems of patients to operate under. Any deviation from the rules would result in citations or fines. He would most likely specialize in motor vehicle collisions and his trauma care would mostly consist of investigating the mechanism of injury. Patients receiving transcutaneous pacing or electrical cardioversion would not receive sedation. Instead, they would be told “If you got shocked, you deserved it”.

Transitioning from a law enforcement job to EMS would require some specialized equipment. Here is a list of essential equipment for MC’s medic bike:

• Baton: Used a long-bone splint.
• Bullet Proof Vest: Used as a make-shift KED.
• Taser: Used as an Automatic External Defibrillator.
• Breathalyzer: Modified to detect CO2 for use in confirming ET tube placement.
• Handcuffs: Made larger for use as a tourniquet.
• Radar Gun: Used as a portable x-ray device.
• Gun: Still used to shoot bad guys…….

Overall, I think MC would be a perfect candidate for a job in EMS. Response times wouldn’t be an issue and scene safety would be assumed. While obtaining blood samples would require a search warrant, pt’s would otherwise not have the ability to refuse treatment. Patient rights would be replaced with Miranda Rights, and patient care reports would be replaced by citations. While the transition would be tough, I think he would fit right in with the rest of us gurney-pushers.

Have an idea for next week’s “Celebrity Medic”? Send me an e-mail at sean@medicmadness.com 

Moving along……

As I am attempting to unwind from the day by having a beer and watching the Texas Rangers kick some Chicago White Sox ass, it occurred to me that ED is much like baseball…..Please, allow me to elaborate……

Emergency Medicine: Lets Play Ball!!!! (A Comparison of the ED and America’s Favorite Pastime) - thekristening.com

If you haven’t read the article, go check it out and come on back when you’re done.

Seeing how well her article played out, I decided to shamelessly steal  expand on the idea and write a comparison of EMS and the game of Baseball.

Batter: (Paramedic) Whether on a street corner or housed in a station, this is the guy that sits in a rotation just waiting for his turn at the plate. The better he and his teammates are, the more times he goes up to bat. The paramedic may enjoy his share of the action, but ultimately just wants to head straight for home.

Pitcher: (Dispatch) The Clash of Titans often occurs between a paramedic crew and a dispatcher. When the dispatcher throws junk calls their way, they try their best to stand back and avoid them, keeping themselves available for the next pitch. That is until that crazy trauma call gets thrown right in the wheelhouse for them to take a swing to get a nice big piece of the ball and send them home with a sense of accomplishment and satisfaction.

Catcher: (Lead Dispatcher) While the dispatcher and medic crew are typically in the center of the spotlight, the lead dispatcher is sitting behind everyone, calling the pitches and directing all the players on the field.

1st, 2nd and 3rd Basemen: (Patients) The patients are always there, waiting, eager to tag you at the most inopportune time. A good and fast paramedic will run right through them all on his way home.

Shortstop: (Frequent Flyer) This person isn’t your average patient. They play the game and they play it well. They are the ones that will jump up out of nowhere and jack your world up before you even knew what hit you. They are known for jumping in the middle of the game at the worst time and stopping you in your tracks on your way to a good run. This person is the vacuum of the field, nothing gets by them and they will suck you dry.

Outfielder: (Firefighters) These are the guys that are usually standing around at a distance unless the paramedic is working. Just when you think you have hit a home run, they are there to jump up and steal the glory.

Manager: (Field Supervisor) This supervisor is the one watching over everything. They get to decide who to put in the game and who to take out. A good team can make the games and their career successful, while a poor team can make for some miserable work days. A good manager will stand back and watch while his team plays the game, making minimal changes when necessary.

Bat Boy: (Supply Tech) This is the guy that the players tend to dump on and is often unappreciated. A good supply tech works fast to clear out equipment and re-supply the team. They often go unnoticed until the one time they slip up and a used ball gets left on the field.

Base Coach: (Base Physician) When the Medics are rounding the bases, this is the person they look to for the go-ahead when they want to run the extra mile.

Umpire: (Law Enforcement) Nuff said.

Fans: (Bystanders) These are the friends, family members, and Monday morning quarter backs that stand around and watch you work. They all believe that they know your job better than you do and are the first to complain when things don’t go their way.

Go Rangers!

Now we just need someone to do write up on the fire service and police department. I’m looking right at you Happy Medic and Motorcop!

Getting to this patient wasn’t easy, as the hallway and living room made maneuvering a gurney very difficult. With me being the lazy bastard creative gurney navigator that I am, I found a route through the back door that seemed much easier than attempting to bring the patient back through the front of the house.

After loading the patient on the gurney, we started through the back door and found that there was no lighting whatsoever in the back yard.

No big deal, I got this.

I instruct my partner to continue forward as I reach for my flashlight. About the time I heard him say “Woah!”, I felt my left foot slipping into what initially felt like a puddle of water……only my foot kept slipping until I was up passed my waist in water. I somehow managed to push the gurney away from me to avoid it falling in on top of me. The next thing I knew, the chief of the volunteer fire department that responded with us was on his stomach trying to grab me, and my partner was pulling the gurney away and asking if I was OK. I quickly jumped out of the freezing water and continued about what I was doing like nothing happened. I turned to my partner and said. “I’m fine, just needed to go for a quick dip to cool off”. I figured I might as well own it with pride.

I had fallen into a fish pond in the patient’s back yard that I obviously was unable to see. I was covered in water, and miserable. My partner suggested that I call the on-duty supervisor and have another ambulance responded so that I could go back to the station to dry off. I respectfully declined and insisted that we continue to St. Furthest.

After 40 minutes of misery, we arrived at the hospital and offloaded our patient. Still soaked in fish-pond water, I stood next to the receiving nurse – completely oblivious to my condition – and gave a bedside report. The conversation went something like this:

After finishing my verbal report…..

Nurse: “Do you have a medication list”

I reach in my pocket and pull out a soaked medication list and slap it on the counter….water and all. 

Nurse: “What the hell happened to to this?”

Sean: “It fell in the fish pond.”

Nurse: (looking at me for the first time) “Whaaa……what the HELL happened to you?”

Sean: “I went in after it.”

Nurse: “Are you kidding me? Why would you do that?”

Sean: “I know how you nurses get when we don’t bring in a med list. It’s called dedication. Have a good night.” (utilizing the biggest shit-eating grin I could come up with).

Not another word was spoken to me from anyone in that ER. I walked out of there like a boss, grabbed a towel on the way out, threw it on the front seat of the ambulance, and looked right at my partner who was still looking at me with disbelief.

Sean: “Drive it like you fucking stole it, I’m freezing”.

Partner: “You know….the only thing that could have made that better, was if you had come out of the water with a fish in your mouth”.

Sean: “Fuck you”

I recently asked my friends on the blog Facebook page how they felt about prayer in the patient care setting and if they had ever done so. To be honest, I kinda expected World War III to break out in the comments, but to my surprise, everyone pretty much agreed that prayer was appropriate when the patient asks for or agrees to it. Many people said that they had indeed prayed with patients, while most admitted to silently praying without the patient’s knowledge. A few said that they had done neither, but still felt it was an appropriate setting to do so.

For the longest time, I tried my best to keep my faith and my work separate. If patients brought up religion, I tried to change the subject. It made me uncomfortable. At the time, my life was going in directions that I wasn’t exactly proud of. I felt that EMS had changed me as a person and it really challenged my faith to the point that I just tried to avoid thinking or talking about it at all. It actually wasn’t until fairly recently that I came to terms with myself, my life and my faith in God. After admitting some hard truths and making a commitment to never let myself slip into that dark place again, I started to move forward and haven’t looked back.

As a Christian, I am of the belief that everyone has their time. I believe that God has a plan, but I also understand that He gave us free will. I absolutely believe that we can affect whether or not somebody lives or dies. As an EMS professional, I think it’s extremely important that we do our very best, every call, every time. We should stay up to date on our knowledge, and we should always strive to be the best care providers that we can. That being said, when it’s their time, it’s their time and there isn’t a thing we can do about it.

A recent encounter with a patient really turned me on to the power of prayer. I transported a middle-aged man to the nearest receiving stroke facility, which was roughly an hour-long drive. He was having stroke-like symptoms, but was alert and oriented. Without getting into too much detail, his CT scan was inconclusive and the sending facility believed that he was possibly having a stroke…..long story…..maybe a good case review for later. I met the patient in his room and noticed right away that he was frightened. He asked me several times during the transport if I thought he was going to die. I tried my best to explain what we thought was going on and I tried everything I could to try to ease his anxiety. He seemed like a very nice man and was very respectful……just scared. It was at that point that I did something I had never done with a patient in my 10+ years in EMS. I asked the man if he believed in God. He said yes. I assured him that we were all going to do everything we could to ensure he returns home to his family in good health and the rest is in God’s hands. I then asked if he would like to pray with me…..and he did. I said a short prayer with him and his demeanor immediately changed. He seemed at peace with what was going on and was very calm. I’m not quite ready to discuss everything that happened during that brief moment, but I can say that it was a life changer for me.

Whether you believe in God or not, you can’t argue that praying for this man made a difference. Sure, you can throw out psychological suggestions, but the simple truth is that it calmed him down and ultimately helped him through the experience. Whether that was an act of God, or a psychological response is irrelevant to me.

Since that call, I have had several occasions where I prayed with patients. Sometimes it’s the best I can do to help them in their time of need. Do I make a practice of this on every call? No. I don’t force my beliefs on anyone, I don’t try to recruit people to attend any churches and I try my very best not to offend anyone. For the most part, the times that I have prayed with a patient has been at their request.

As healthcare professionals, we are supposed to be patient advocates, and that doesn’t stop at the protocol book. If prayer is what a patient needs to help them through a tough situation, then I see no problem in participating or even leading.

I know this can be a touchy subject, but I would love to hear your views and experiences on the matter. Have you prayed with / for a patient? What are your thoughts on the subject?

What kind of paramedic would Napoleon Dynamite be?

Napoleon would most likely work for a small, rural EMS service in his home town of Preston, Idaho. He would have most likely been inspired to take up work in EMS after his grandmother’s quad accident that left her with a broken coccyx. Chances are, he would still be living at home, which would work to his benefit being that the ambulance service he works for only pays a dollar an hour.

He would most likely be paired up with his best-friend Pedro, who would be rather quiet but would do most of the driving. They would most likely respond on Pedro’s bike, taking it off plenty of sweet jumps on the way to calls. This, of course, means that Napoleon’s crew would be limited to first-responder duties. Patient transport would be completed by Uncle Rico and Kip, using Uncle Rico’s van.

Scene safety would be handled by Rex, from “Rex Kwon Do”, and his wife Starla. They would be dispatched to all of Napoleon’s calls to ensure that the scene was clear.  Rex would provide these services at a cost of $300 every 8 weeks. For an additional fee and a promised vote for Pedro, you could also receive on-the-spot personalized protection by Pedro’s cousins.

Protocols for Napoleon’s ambulance service would mostly consist of “doing whatever I feel like doing…..gosh!“. More specifically, hypoglycemia would treated by administering tater tots that Napoleon stores in his pocket. Trauma care would be provided in the form of prevention, using Uncle Rico’s time machine to travel back before the incident and stop the traumatic event before it happens. Instead of outlining interventions that Napoleon could perform, there would just be a list of “skills”.

Instead of doing a traditional bedside report at the receiving hospital, Napoleon and Pedro would hand off patient information in the form of a skit or current event presentation.

Documentation wouldn’t be completed in the form of a traditional or electronic PCR. Instead, Napoleon would draw animated pictures of the patients that he transported in a scene that describes their condition and what they looked like on arrival.

Uniforms would include black snow boots, white shirts with “big sleeves“, and round buttons featuring “Glamour Shots By Deb” for identification.

In conclusion, I feel that flexible protocols, a tiered response system, time travel capabilities, and a massive set of “skills” would all contribute to a efficient and effective delivery of pre-hospital medicine.

Have an idea for the next “Celebrity Medic”? Send me an e-mail at sean@medicmadness.com. 

We all know this guy that carries a laryngoscope in his back pocket and measures his success by the amount of “tubes” he got this rotation.

Overheard in the station after returning from a call:

Sean: “You guys ever been to Europe?”

Other Crew: “Ummm….No. Why?”

Sean: “Cause…..Yer’ Up”

Determining what crew is up for call can be a very simple or complicated process. In my years in EMS, I have seen call rotation rules that were extremely straight-forward and simple and some that rivaled the federal tax code in complexity. Anybody that has experienced station life with more than one ambulance on-duty knows exactly what I’m talking about.

For the most part, the call rotation rules I have seen were made in-house by the crews assigned to the shifts / stations. As long as the calls were made within the allotted time, nobody in management cared. Likewise, the crews involved knew that it was in their best interest that management not care or get involved. Most people have the understanding that once management gets involved, rules get made that nobody likes.

A wise man once told me that “sometimes you eat the bear, and sometimes the bear eats you”. This is especially true in EMS and I’m a firm believer that no set of rules can change that. I always get a laugh out of crews that come up with complicated call rotations in an attempt to make things “fair”. For example, here is a set of rules I had to follow at one point in time:

You are up for call until you:

• Transport a patient to the hospital.
• Run 2 dry-runs.
• Make it past a specific location (railroad tracks, intersection, road marker, etc)
• Fly a patient out.
• Complete 2 post moves.

Not to mention that being “first up” was contingent on whether or not it was an even or odd day.

I’m fairly certain there were more rules, I just can’t think of them all. Below is what I go by now:

You are up for call until you:

• Turn the wheels on your ambulance.

Personally, I prefer the simpler of the 2. Sure, sometimes you kinda get screwed, but it’s consistent. If the crews watch each other’s back and aren’t asses about the rotation, it can be a really fair system. For example, if my counterparts have been running like crazy, and I have had nothing but dry runs or canceled calls, I’ll volunteer to take 1 or 2 to allow them to eat, do paperwork, etc. Even we choose to take the completely selfish route, it still evens out in the end.

I’m curious to here other stories about call rotations. What are some crazy rules that you have had to follow?

I turned on my computer today minutes before the explosions happened and started my usual routine of reading e-mails and catching up on the news. Less than 1 minute after the explosion, I noticed a friend of mine post “I’m safe and away from danger”. I knew he was in Boston for the marathon, but had no idea what he was talking about. Seconds later, several people commented on his post in relief that he wasn’t harmed. Still confused, I looked back at the national news site that I was reading in hopes to find out what happened. Nothing. I looked back to my Facebook timeline and Twitter feed to find several people posting about an explosion that happened in Boston, all before the news could even get the initial reports out. I knew of 2 more people that were at the event and I immediately started scrolling down my Facebook page to see if they had updated anything. Same thing. A quick “We are OK” was posted to let all their friends and loved ones know that they were safe. What I witnessed right there was the true power of social media. I never turned on my TV, and never wound up reading a single news article. The Boston Police Department was updating their Twitter feed regularly to keep everyone informed, and several people at the event were posting pictures and posts about what was happening.

What I noticed the most, was the overwhelming amount of people offering their  support to all those affected by this tragedy. I saw first-responders wishing they were there to jump in and help, the on-line church group that I participate in asking people to give them names of people involved so they could pray for them and others were already talking about donating blood and money. This is what America is all about, and this is why I believe that we live in the greatest country on Earth.

It wont take long before we start pointing fingers at each other. Once the blood dries and the smoke clears, the usual politics will take place. Right vs Left, Republican vs Democrat, Obama this, Bush that, etc. Unfortunately, some of this has already started. If we can’t blame one another for the actual act, we will find a way to accuse the other side of either not doing enough to prevent it or not doing enough after. The important thing to remember is that evil exists and if we don’t stand up and fight against it, it will win every time. As free-willed individuals, we will never agree on everything and that’s OK. But let’s not lose focus on what’s important. Lets stick together as Americans to help one another and stand united to fight the evil forces that wish to cause us harm.

My deepest thoughts and prayers go out to all those involved in yesterday’s tragedy.

The phrase “scene safety” is hammered into our brains all throughout our training. Dispatchers try their best to make sure the scene of an emergency is safe before “clearing” us to make entry, we assess for hazards before making patient contact, and we watch each other’s backs at all times. We wear gloves to prevent the spread of disease, seat belts to protect us in the event of a collision and safety vests to lessen the chance of being struck by a motorist on the side of the road. We drive at safe speeds to reduce the chance of vehicle collisions, we lift with our knees instead of our backs to prevent back injuries and if somethings smells or looks funny, we leave it alone so we don’t get sick. Our biggest job is going home at the end of the day. We try our best to stay out of harms way and make it home to our families every shift.

But how do we protect ourselves from this?

Brown called 911 and said he was suffering from chest pains, and five Gwinnett County firefighters arrived at 3:48, believing it was a routine call, said Police Chief Charles Walters. Brown was lying in bed and appeared to be suffering from a condition that left him unable to move. But when they approached the bed to help him, he pulled out a handgun, Walters said.

Source: http://www.ems1.com/fire-ems/articles/1430652-Firefighter-hostage-gunman-planned-kidnapping-for-weeks/

A man calls 911 complaining of chest pain. A Routine call, right? He acts like any other patient when he speaks to dispatchers. There are no obvious dangers in front of, or inside of the residence. He is calm and presents like many of our patients do. No danger here, just a routine medical call. I can only imagine that the responders involved with this incident didn’t expect to become hostages when they reached the bedside.

I have often feared incidents like this. The fact is, we are never safe. We are easy targets and we carry what many people want. I’m not the slightest bit surprised that this happened. What does surprise me, is that this doesn’t happen more often.  It should be no surprise that a deranged individual would pick a target such as a paramedic or firefighter. They know we aren’t armed and they know we will come inside their home to any room they choose.

Fortunately, this guy had motives other than immediately killing the responders. The 4 firefighters who were shot while responding to a structure fire last December, weren’t so lucky:

WEBSTER, N.Y. — A gunman ambushed four volunteer firefighters responding to an intense pre-dawn house fire Monday morning outside Rochester, N.Y., killing two before ending up dead himself, authorities said. Police used an armored vehicle to evacuate more than 30 nearby residents.

Source: http://www.ems1.com/safety/articles/1384752-4-firefighters-shot-2-fatally-in-western-NY/

Nobody anticipates getting shot at a structure fire, and we shouldn’t have to, but that is the world we live in. There are a lot of bad people out there that wish to cause harm and we must prepare ourselves so that we can respond appropriately. There is simply no way to prevent incidents like this. There aren’t enough cops to secure every scene before we enter and we haven’t developed a way to read minds. That leaves us with 2 choices. We either continue to do business as usual and place ourselves at the mercy of people that wish to cause harm, or we prepare ourselves so that we don’t become victims. I make no secret about the fact that I support concealed carry for EMS providers, and this is exactly why. We run into the same neighborhoods and deal with the same people that the cops do, only we have no way to defend ourselves.

Any time I bring up the argument about concealed carry in EMS, I get the “we’re not cops” and “we shouldn’t be entering unsafe scenes” response. Guess what, guys? There are no safe scenes. Another popular argument is that we use “Verbal Kung Fu” to talk our way out of situations. That doesn’t do much to stop a 9mm round. We take every precaution possible to avoid placing ourselves in harm’s way, but we simply can’t stop these things from happening. In both of the cases mentioned, the responders did what any of our peers would have done. They didn’t try to be a hero or engage in conflict. They just showed up to a call for service and found themselves becoming victims.

I’m not asking anyone to “issue” guns or mandate that paramedics or firefighters carry firearms. All I’m asking is that I not have to check my right to self-defense at the time clock. If I have a legal right to carry a concealed firearm – whether it be via carry license or state law – then why can’t I continue to do so at work?

I often hear people argue that if tighter gun laws and further restrictions on private ownership could save one life, then it would be worth it. Well, let me ask you the same thing. If allowing our responders to carry a firearm could save one life, wouldn’t IT be worth it?