How about some EMS Humor

After the last post, I thought some humor might be in order. It’s old but always makes me laugh. I present the following memo:

To: All EMS Personnel
From: Director of Operations
Subject: Proper Narrative Descriptions

It has come to our attention from several emergency rooms that many EMS narratives have taken a decidedly creative direction lately. Effective immediately, all members are to refrain from using slang and abbreviations to describe patients, such as the following.

Cardiac patients should not be referred to as suffering from MUH (messed up heart), PBS (pretty bad shape), PCL (pre-code looking) or HIBGIA (had it before, got it again).

Stroke patients are NOT “Charlie Carrots”. Nor are rescuers to use CCFCCP (Coo Coo for Cocoa Puffs) to describe their mental state.

Trauma patients are not CATS (cut all to sh*t), FDGB (fall down, go boom), TBC (total body crunch) or “hamburger helper”. Similarly, descriptions of a car crash do not have to include phrases like “negative vehicle to vehicle interface” or “terminal deceleration syndrome”.

HAZMAT teams are highly trained professionals, not “glow worms”.

Persons with altered mental states as a result of drug use are not considered “pharmaceutically gifted”.

Gunshot wounds to the head are not “trans-occipital implants”.

The homeless are not “urban outdoorsmen,” nor is endotracheal intubation referred to as a “PVC Challenge”.

And finally, do not refer to recently deceased persons as being “paws up,” ART (assuming room temperature), CC (Cancel Christmas), CTD (circling the drain), DRT (dead right there) or NLPR (no long playing records).

I know you will all join me in respecting the cultural diversity of our patients to include their medical orientations in creating proper narratives and log entries.

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Unpleasant Firsts

I’ve been in EMS for about eight months now.

Side note: Wow, time flies!

Anyway… in my eight months as an EMT I have, of course, seen loads of stuff that has pissed me off, made me shake my head and things that have made me question why God would allow humanity to continue. Tonight I had one of those moments where in my mind realizes what I’m seeing is something that no human being should ever have to see.

As we say in EMS, I had a crispy critter.

I had my volley radio on and heard dispatch page out a neighboring department for MVC with entrapment and also advised that the car was on fire. I started putting on my shoes because I just knew my department would also be paged. Sure enough, the tones drop and I’m out the door. The rescue truck was already pulling out of the station when I got there so I followed in my POV. Before we even arrived, we heard units from the primary FD go on scene. About a minute later they called for the ME.

We get there, gear up and help out with putting the rest of the fire out. After the coroner arrives and does his thing, I helped get the body out of the car. We load her up and send her on her way.

Seems pretty simple, huh?

The entire time I’m there, I’m just looking and observing. This was my first burn victim and I couldn’t absorb all that had happened fast enough. I’ve always been told that the smell of a burned body is something that you’ll never forget. That tidbit is absolutely correct.  The sights are also something I’ll never forget. By the position of the body, I could tell that she had obviously been in a great deal of pain but that she was also struggling to get out of the car by any means possible.  Her shoes (obviously with her feet still in them) had melted to the floor. Most of her skin had been burned away too. Muscles, tendons, organs, the whole works was in plain view. I couldn’t help but think, “wow, this would actually be a good lesson in A&P.”  I also couldn’t help but feel bad for her family. She’s a member of a family somewhere and they’re missing a loved one tonight. There wasn’t anything we could have done to save her but it still sucks hardcore.

It also really sucks that this had to happen on Easter.

I’ll certainly never forget tonight. The sights, the smells, the whole experience will always stick with me. Here I am writing at around 0200 while my wife is asleep next to me. I just had to get it all out I suppose. For the therapists out there who want to know how I feel… well, I haven’t quite decided. Of course, I’m sad that there was nothing that could be done to save her life but I also know that it just wasn’t meant for that to happen tonight. I feel sadness for her and her family. No one should ever have to get the news that their loved one burned up in a car and no one should ever have to die such a horrific death.   I certainly hope that I never see anything like this again but I know that there’s a good chance that I will see it again, probably more than once.

It’s a good reminder to always take the time to tell your loved ones that you do love them. You never know when you’ll be answering your last call or otherwise leaving this world.

Rural EMT-B

Trauma

As a preview, I wanted to go ahead and post on here that the NBC garbage show known as Trauma is apparently back on the air. I don’t have the time to post my extended thoughts on this show right now but I will do my best to get a post up tonight that goes into more detail. A good summary would be to say that the show is junk and portrays EMS as irresponsible and does nothing to increase the fact that we we are legitimate medical practitioners. In fact it makes EMS look very unprofessional and reckless.

You can go here to view the show for yourself. Don’t be surprised if you can’t make it past the first five minutes though.

You Can’t Treat Stupid

This post will probably be a bit random however I hope there will emerge a theme.  Thanks to something I just saw on Twitter I have the phrase “you can’t fix stupid” stuck in my head.

The last few days have been full of stupid.

There was a pretty good battle going on Twitter earlier between the Twitter EMS community-at-large versus one blogger.  His blog, “Rethink EMS,” is a somewhat interesting read.  Pretty much, the interest only extends to being shown an example of “those who don’t know what they’re talking about shouldn’t be telling me how to do my job.”  To sum it up, he’s just some guy who doesn’t work in EMS, never has worked in EMS and does not want to work in EMS.  Yet, he knows everything about EMS including what treatments work and don’t work.  He contends in his post that he would do away with ALS if it were up to him and even goes on to call for an end to intubation outside of the hospital.  Oh, he even says that pain management in the field is unnecessary.

Really?

While I’m sure he means well and I’m sure he’s done his research, he fails to see the big picture.  Does he really expect us to withhold pain management from a patient (assuming the service is ALS and a medic is on board)?  At my place our transport times are routinely 20 minutes or more. You’re telling me that my medic partner shouldn’t be allowed to deliver pain meds, even if this patient has a compound fracture?  Would he want his mother treated in this way?  How about himself?

That’s just one example.  I won’t even mention intubation which is obviously effective where the airway and oxygenation are so compromised that such a drastic measure would be necessary.  Contrary to what he contends, these measures typically would not delay hospital care.  Is ALS always needed?  Of course not.  In fact, I’d say most of the calls I encounter are truly a BLS call but there have also been plenty of times where ALS intervention was needed and did not cause the patient any harm nor did it delay definitive care.

The truth is, this guy is likely just misguided in his views.  At least that’s what I hope.  He cites many studies and much research but really what does it prove?  The studies he cites have not been policy changers in EMS, nor should they be.  Neither do I think that someone who has little, if any, EMS training, let alone medical training of any kind, should be telling us how to do our jobs and what protocols to keep and which ones to ditch.  This kid thinks that someone should only get ALS care if they’re circling the drain.  I’m sorry but I disagree.  The patient should start receiving care immediately whenever possible (and it usually is).  This includes pain management and advanced airway management if indicated.  For him to sit in his chair and tell us that what we do is wrong, well, it kind of chaps my rear.  I hope he gets educated about what it is we do and why we do it.

May more education happen for all of us at that.

The Rural EMT-B

Things That Make You Go “What??”

In my short EMS career, I’ve already gone on those calls that make you go “you called 911 for this” several times.  The reasons that people will call an ambulance in the middle of the night are more varied than I would eve want to attempt to dissect here but I’ve run a couple recently that made me want to kick something.  Hard.

We got a call from a lady who called and said she needed an ambulance because “my foot is hurting.”  Now, before I go any further, all of us in EMS know of the stereotypical call where someone will call an ambulance for a hurting foot or a stubbed toe but I never actually thought this would happen.  I almost had to stifle a laugh but I acted like a pro.  Anyway, my medic partner was listening on the extension and just shaking his head.  After we got off the phone he looked at me and said, “that foot better be about to fall off.”  We rolled to her house (code 1, in case you’re wondering – no way we were turning on the disco for this) and she met us in the living room.  As you might have guessed, her only complaint was non-traumatic foot pain.  “I think it’s gout and I don’t have any pills.”

I should also note that there was a car in her driveway.  Also, she evidently couldn’t find a ride back home because another truck took her home later that morning.

On the same shift at about 0300, the phone in the sleep room rings.  The ER had taken a call for an ambulance.  I should have known it wasn’t a good sign when the nurse said, “don’t be in a big hurry getting down here.”

Uh-oh.

We get downstairs and get our call slip.  “Itching?!  He’s itching.  At three in the morning, itching is an emergency.”  My partner was clearly pissed (as was I).  “He’d better have scratched a hole in himself and be bleeding” was my partner’s response.  Again, we roll code 1 and find the guy waiting for us in the living room (I’m sensing a theme here).  “My doctor said several years ago that I have dermatitis.”  I asked him, “Sir, if you’ve had this condition for a long time, what changed to make you call for an ambulance in the middle of the night?”  “I can’t sleep because of the itching, it’s driving me crazy.”  So we take him despite the fact that he, too, had a car and even had a wife to drive him to the hospital and despite he not being in any sort of distress.  I should also point out that neither I nor my partner saw him scratch himself the entire time we had contact with him.

My agency, like many others, has a policy that we can’t refuse a call and we have to transport, no matter what, if the patient wants to be transported.  I understand this and everything but where does one draw the line?  A blogger from the UK has also appeared in the EMS reality show “The Chronicles of EMS” and he mentioned during the pilot episode that EMS over there can refer a patient to their personal doctor rather than taking them to the ER.  Why don’t we do this more in the US?  Calls like the ones I just mentioned are a strain on resources, especially in a rural setting.

I shouldn’t have to state that calls like this can tie up a crew from being able to go to a real emergency but a lot of people don’t consider that.  We have people who can either take themselves to the hospital have someone take them and people who don’t need to go in the first place who look at EMS as nothing more than a taxi with bright lights and a noise maker that they can call whenever they have a stuffy nose or a hurting foot.  EMS is anything but a taxi service.  How we remind people of that is a matter of much contention.  How do you balance the right of someone to seek and receive medical attention with ensuring that resources are used properly?  Education, sure, but how do you deliver it?

Quite honestly I think the only way people will learn these facts will be “the hard way.”

I’m not sure people will really “get it” until they call for a sore foot and we can tell them “sorry, you can take some OTC meds and follow up with your regular doctor if needed but we’re not tying up our ER or ourselves any longer.  We are for emergencies only and this does not qualify as an emergency.”  I’m not sure if any places in the US do this now but I sure wish we could at my place.

Abuse of the system is a huge problem everywhere and I’m glad that some agencies such as Cleveland (Ohio) EMS have taken steps to reduce the abuse that occurs.  Part of the change we are seeking in EMS should be to get away from the “you call, we haul” mentality.  This ties up often limited community resources (EMS), clogs up our emergency rooms with clinic-type traffic and sends the message that the ER is, in fact, a 24/7 clinic and that EMS is a taxi service.  EMS personnel should be allowed to tell a patient that they don’t need to go to the hospital when they don’t and there should be some kind of punitive system in place for people who constantly abuse the system.  I know that this would walk a fine line but a balance has to be there somewhere.

What do you think?

Rural EMT-B

“Oh Crap!”

Everyone in EMS has had that moment that makes you go “oh crap” (or whatever your phrase of choice may be).  It could come at any moment, on any type of call and often will happen more than once.  In my short six month career, I’ve already had my first.

Maybe it was God’s way of saying “don’t get cocky.”

I ran a call on the volly truck I ride with sometimes.  Dispatched as a fall in a town close by (the county has a paid EMS but they didn’t have a truck available) and he was unconscious.  We arrive on scene and the gentleman is talking to his home health nurse and doesn’t appear to be in any immediate distress.  He wants to go anyway so we package him and get him ready to go.  After we got him loaded, I started my assessment and all the normal stuff.  The trip to the hospital was uneventful unless you want to count his non-stop talking as an event.  We arrive at the ER and take the PT in, get a room and a tech is just finishing making up the ER bed when we get in.  The driver and I are about to lower the stretcher.  Then my moment happened:

The stretcher falls completely to the floor and flipped on its side with the patient still on it.

“Oh crap!” ran through my mind.  Ok, fine… it wasn’t so polite but at least I didn’t say it out loud.  Next thing I know, half the hospital rushes in along with the EMT from another EMS that was there with a patient of their own.  We right the stretcher and get the patient moved onto the ER bed.  He’s laughing.  Laughing, I say!  He wasn’t hurt, wasn’t complaining of any pain and thought it was hilarious.  We also couldn’t find any visible trauma on him so at least we had that going for him (and us!).

It took me a little while to calm down and it really bothered me the rest of the day.  “Hey, it’s happened to me too.  Let it go” was the advice I got from a few people, including the EMT who was there with another EMS.  After we returned to the station I called the director to let him know what happened and that I had documented the accident.  “How in the hell did that happen?!”  The simple fact of the matter is, I don’t know.  Neither me nor the driver had our hands on the head and rear releases (the stretcher is one of the old Ferno models).  I was trying to unlock the stretcher so we could lower it and I hadn’t even unlocked it before it fell.  The only explanation I could come up with was simple mechanical failure.

After the director and I got off the phone I came home but couldn’t stop thinking about it.  Sure, the PT was fine and even thought it was funny but what if he had been injured?  What if I get sewed?  What if it happens again?  I finally had to just relax because I had a shift at my paid job the next day and I needed to be ready for that.

We had a meeting the other night and I found out that we’re taking delivery of a new (to us) Stryker that’s in excellent shape, has been tested and was donated to us by another EMS in the area.  I felt much relief after hearing that.  Surprisingly the specific incident didn’t come up but we were all reminded to take great care to ensure patient safety (not to mention the safety of ourselves) at all times.

I’m very grateful that this didn’t turn out as bad as it could have and that the end result (new equipment) turned out good.  Last I heard on the patient he was doing great and wasn’t mad at us.  It gave me a valuable lesson too:  Even in the ER, anything can happen at any time for any reason.  Be prepared and always expect the unexpected.

And even expect the patient to think scary moments are hilarious.

The Rural EMT-B

Dispatch Dilemmas

EMTs and paramedics are, of course, medical professionals.  We’re trained in performing pre-hospital and out-of-hospital medical procedures, how to give meds, etc.  However, I also know that we need other components to work like they should in order for us to do our jobs effectively and also to ensure the safety of ourselves, our partner and the patient.  Sometimes the people we rely on to give us the help we need to perform our duties and to provide for our safety can fail and when that happens, well, the results can obviously end up not good.

The resource I want to concentrate on today is dispatch.

At my paid EMS job, I have to tolerate grossly incompetent dispatchers to the point that I feel the safety of me and my partner is often at risk.  The county 911 PSAP does our dispatching.  I’ve become convinced that none of them are certified telecommunicators and I’ve also become convinced that they have the collective brain power of a gnat.  Here are but a few examples of things I’ve had to endure:

• Recently my unit was dispatched to a MVC on a busy highway.  Unknown number of patients (evidently they didn’t ask), unknown entrapment and did I mention that it was on a busy highway?  We get en route and ask them to dispatch the fire department.  After that, the dispatcher comes on the radio and says, “Be advised we have state police en route and a fire fighter reported the wreck and is on scene. Do you still want me to page the fire department?”  “Yes, please.”  She sounded pissed and said, “Ok, we’ll page them.”  They also failed to mention that there were three vehicles involved and four patients.  Obviously it would have been good to know that so we could have rolled two ambulances right away instead of me having to call in for one after my truck got on scene.

• I took a call about a patient who was having an active seizure.  The scene was several miles out in the county and, since we’re based at the hospital in town, it was going to take us quite a while to get there.  I asked for them to page EMRs from the fire department to assist.  “Are you sure you need them?”  “Ma’am, I’d rather have them there and not have need for them than for something to happen to the patient (read: the patient codes) before we arrive and they not be there.”  We were a few miles from the highway we had to get on in order to get to the road where the call was and they waited to page the EMRs until we were almost to the main highway (which took about five minutes)

• Responded to a psych patient who was reported to be violent.  Before I got off the phone on the initial call taking, I asked dispatch to send law enforcement to secure the scene.  We go en route and hear nothing on sending the police.  Got on the radio and asked again.  Then I had to ask again a couple of minutes later.  Dispatcher called the truck phone and said, “You aren’t even on scene yet, how do you know you need the cops?”  Was she serious?!  “Ma’am, as you heard on the phone call that YOU forwarded to us, the patient was reported as being violent.”  We had to stage down the road for several minutes while we waited for law enforcement to arrive and secure the scene.

These are but a few examples.  Incompetent dispatchers are a huge danger to us and to the general public.  In these situations the dispatchers failed to do the jobs they’re supposed to be doing which is gathering as much information as they can to ensure we can perform our jobs safely and that we have the resources we need in order to care for our patients.  Sending the fire department to a MVC should be a given so that they can extricate the patient from a car if needed.  Sending EMRs should also be a given in a lot of medical situations.  I’m not sure how their SOPs read but I think it’s absolute madness that we have to ask them to send us help that most places get automatically (and often we have to ask them more than once).

I couldn’t find anything online but I would speculate that EMS people have been hurt or killed because of a failure of dispatchers to do their jobs properly.  If anyone has any stats or news links on this, please feel free to post them in the Comments.

Along with reforms in how pre-hospital and out-of-hospital care is delivered, we should also seek reforms in the other areas that support us, specifically dispatch.  I would like to see a national standard for dispatch training and certification.  I would also like to see enforcement of a PSAP’s SOPs and to know that if a dispatcher drops the ball they will be retrained or dealt with more severely if they’re habitual offenders.  I’m a former dispatcher myself and I’m fortunate that I was trained on how things should be done at an agency that is pretty progressive.  It drives me crazy to see that, all too often, dispatch is neglected, improperly trained and that lives are put at risk when dispatchers either can’t or won’t do their jobs.  It’s time we demanded better training for our dispatchers and more accountability from them as well.  I would hate to know that a life was needlessly lost because of an ineffective dispatcher.

The Rural EMT-B