All Are Born Mad

If you've read this blog for any length of time, you know I believe we c-spine waaaaaaaaay too many people.
The procedure is one of our Sacred Cows in EMS, and we do it with abandon.
5 mph fender-bender with no visible damage to either car? Board 'em!
Drunk college student trips and lands hard on their bum? Board 'em!
Nana Noodles farts? Board 'em!
Why do we do it so often?
Sometimes I think it's from an over-abundance of caution.
Rarely because it seems like it's in the patient's best interest.
But most often I think it's another example of the CYA-based medicine we are forced to practice in this state, because we all know how reluctant the Powers That Be would be to make any medic or EMT's life miserable if, from Boston and after the fact, it were deemed a mistake to not c-spine a particular patient.
(Note: and if you're wondering, the answer is "not at all reluctant." Plenty of good medics and EMTs have felt the wrath of the almighty bureaucracy here)
I wrote a post a few months ago that talked about a study that showed that placing c-collars on the few patients for whom they are actually made could contribute to their deaths.
You can read that post here.
In another study that highlights why working in EMS in Massachusetts is like being trapped in a perpetual production of "Waiting for Godot," ("All are born Mad, some remain so"), earlier this year The Journal of Trauma reported on some interesting -- and disturbing -- findings regarding penetrating trauma and c-spine immobilization.
Before we review the results of the study, let us think for the moment what hell would befall any medic or EMT in this state who showed up in the trauma bay with a patient with a gunshot wound to the chest without c-spine immobilization.
The folks in Boston would undoubtedly unleash an investigation for the ages, and certainly a suspension and lots of "re-training" would follow.
But what the Journal study points out is that those medics and EMTs probably deserve a medal for doing -- or not doing, actually -- what the evidence, rather than a protocol book, says is in the patient's best interests.
What the study found was pretty dramatic.
There are two main take-home points:
1 -- in patients with penetrating trauma, those who are c-spine immobilized die twice as often as those who aren't, and
2 -- it takes 1,032 c-spine applications in penetrating trauma to benefit 1 patient (defined in the study as patients with incomplete spinal injury who ended up needing spinal surgery for vertebral spine repair, spine fusion, laminectomy and/or halo placement). It takes just 66 c-spine immobilizations to contribute to a single patient death.
The study authors performed a restrospective analysis of 45,284 victims of penetrating trauma listed in the National Trauma Data Bank, and concludes simply: "Prehospital spine immobilization is associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma."

A New Foe

It's hard now to remember a time when the departure of the New England Patriots seemed like a possibility.
In the early 1990s it wasn't just a possibility, it seemed like a done deal.
And then a bunch of good things happened, beginning with the hiring of Bill Parcells and the drafting of Drew Bledsoe out of Washington State University.
But there were lots of other contributions on the road that turned the Patriots into a dynasty instead of a 25-year footnote in NFL/AFL history.
One of them was a catch by a fullback out of the University of Alabama named Kevin Turner.
On a cold Sunday in November 1994, Drew Bledsoe threw a game-winning touchdown to Turner, capping what was, at the time (pre-tuck-rule, pre-snow-bowl, pre-multiple Super Bowl wins), perhaps the greatest comeback in Patriots history, an improbable 26-20 OT win over the Vikings.
Probably not many people remember that catch, but for me it was an incredible moment, and although the Foxboro crowd cheered the team off the field chanting the name of its new strong-armed QB hero, it was Turner's heroics that I've always remembered.
Turner played just three seasons for the Pats, then six more in Philadelphia before calling it quits.
He was my kind of player -- blue collar, hard-nosed.
Now, Turner finds himself in the fight of his life, recently diagnosed with ALS, aka Lou Gehrig's Disease.
But Turner's fight may also provide some ammunition against a newly-discovered disease called Chronic Traumatic Encephalopathy (CTE) -- recently identified by researchers at Boston University -- in which patients subjected to repeated and significant head trauma seem to develop an ALS-like syndrome that is currently even more poorly understood than ALS itself.
You can read this excellent article from Boston.com about Turner's plight and this new disease.
I wish Turner nothing but the best.

North Brookfield EMS Ends ALS Run

A quick update from a story I first wrote about two years ago.
It looks like North Brookfield EMS has lost its battle to stay in business.
According to reports in the local press, NBEMS has informed Selectmen that it intends to end 24/7 full-time service, drop its ALS activities, and return to service as a call and volunteer BLS system.
I don't know who will be offering ALS service to North Brookfield and New Braintree, but I'm sure they never would have made the decision to downgrade without ensuring there was a substitute in place.
This is a bummer, but times are tough all over and ALS is expensive to maintain, especially at low-volume rural providers.
One figure I heard was that it cost over $500,000 annually for NBEMS to staff three full-time Paramedics.
I don't know what their revenues were like, but I'm certain it was nowhere near half a million dollars.
I commend the NBEMS folks for realizing that they can't adequately pay for an ALS service and not entering into the charade certain other towns in our area have chosen to partake in, where they maintain "24/7" ALS coverage on paper, while the reality is something different altogether.

Primum Non Nocere, Mostly....

It would be ironic if it weren't tragic.

Imagine a procedure we perform tens of thousands of times per year, knowing that 990 of every 1,000 occurrences are a complete waste of time.

But we rationalize it, deciding that the procedure is harmless for the 990 patients for whom it is unnecessary, and for the remaining 10 -- well, it can be positively life-saving.

Or so we think.

All such rationalization is moot anyway -- the bureaucrats who plague our profession have proven more than willing to suspend any medic or EMT who fails to do this procedure despite the indications, or lack thereof, and lots of tort lawyers (those are the guys with the bad hair, billboard ads and late night TV commercials) have paid for their summer houses on the Cape under the auspices of that old rule that says certain kinds of back pain are hard to disprove.

Now imagine that that procedure turns out to be not only useless for most patients, but potentially fatal to the 10 critical patients for whom such exacting adherence to the rules exists in the first place.

That's exactly the situation we face today, with our blind application of cervical collars and longboards to everyone who in any way suffers the effects of misguided kinetic energy, no matter how trivial or brief.

So it was with a mix of fascination (because it was fascinating) and frustration (because I doubt things will change) that I read an article this week challenging one of the most basic precepts of EMS.

The latest issue of the Journal of Special Operations Medicine includes an article by Dr. Peter Ben-Galim, of the Spine Research Laboratory at Baylor College of Medicine, where he is also an assistant professor of medicine.

In it, Dr. Ben-Galim comes to two interesting conclusions:

1 -- there is no evidence that a c-collar "can truly prevent abnormal motion of a severely injured spine in a trauma patient," and,

2 -- after experiments with fresh cadavers and examining other physical evidence, Dr. Ben-Galim found that for patients with unstable spine injuries, "the collars may be doing more harm than good," including all sorts of devastating sequelae, including death

In other words, there's no proof that what is perhaps the single-most common procedure in EMS (ie, aggressive c-spine immobilization as currently practiced) does even an iota of good, while there are some pretty significant indicators that it could be fatal to the statistically tiny fraction of patients for whom the whole megilla was concocted in the first place.

Like I said, it would be ironic if it weren't tragic.

Dr. Ben-Galim's conclusions were based on research he and his colleagues in Houston conducted on fresh human cadavers, on whom various c-spine immobilization devices were applied after a process in which the cadavers were frozen, then re-warmed to room temperature (there being a strong correlation between spinal movement in uninjured, asymptomatic living humans and room-temperature cadavers).

The research team surgically severed the ligaments holding high cervical vertebrae in place (C1 and C2), and fractured the odontoid, a small bone that extends from the beginning of the axis to the opening of the atlas, alongside the spinal cord.

Typically, these conditions result in instantaneous death, though Dr. Ben-Galim notes that there are almost two dozen instances in the literature of patients surviving this condition (aka internal decapitation).

The researchers then applied a properly-sized cervical collar and compared the resulting anatomical changes using flouroscopy and CT scans.

In EVERY SINGLE case, the "proper" application of cervical collars resulted in gross and potentially fatal separation between C1 and C2.

"The current presentation of our data supports several previous studies in suggesting that extrication collar designs can effectively push the head away from the shoulders, resulting in grossly abnormal displacements between the occiput and the spine," Dr. Ben-Galim writes. "Although these collars are applied to millions of trauma victims each year with the intent of protecting against secondary injuries in the RARE CASE of a serious cervical spine injury, IT IS IN THESE VERY UNSTABLE SPINE INJURIES THAT THE COLLARS MAY DO MORE HARM THAN GOOD." (Emphasis mine)

Dr. Ben-Galim applauds the move away from in-line "traction" to "stabilization" in EMS over the recent years, and encourages research into new ways of c-spine immobilization.

"These observations," he concludes with great understatement, "raise the question for a need of an entirely new concept of EMS and pre-operative cervical spine and head stabilization."

Of course, in EMS you can raise the question, it all just depends on who's going to provide the answer.

The Real Fraud and Freeing The Massachusetts 200

Just over 200 Massachusetts EMTs and Paramedics began serving suspensions today of 9 months to two years, accused of signing rosters for bogus Refresher courses and lying to state officials.
Most of those suspended who worked for private ambulance companies are now also out of work, summarily fired the moment their names appeared on the state's list of the accused.
Certainly there is no defense for lying or, in the case of people who may have taken overtime money for classes they never went to, stealing.
But talk to enough people involved in the case and you realize pretty quickly that the guilt of many of the punished is far from certain.
In the ensuing brouhaha, a whole cabal of state officials, private ambulance company spokesmen and various fire department officials have gone to great lengths in the press to assure the public that they have reviewed every call completed by all 200+ EMTs and Paramedics in question and have found no instance of any kind of adverse patient outcome related to any of the medical treatment they provided.
IN OTHER WORDS, despite not completing refresher training so crucial to the safety of the Commonwealth that the state has seen fit to bankrupt and send to personal and professional ruin over 200 hardworking members of an already underpaid, underappreciated profession, NOT ONE CITIZEN was hurt or received subpar care.
I think we were meant to be placated by such good news, but I am merely perplexed.
If this training is SO important, why is it so clearly meaningless, and utterly unconnected to patient outcomes????
And if this is obvious to me, why don't I hear anyone other than other EMTs or Paramedics asking the question publicly?
Having completed numerous refreshers since 1995 both as an EMT and a Paramedic, I can say with complete confidence that the recertification process may sound good on paper, but in reality is a colossal waste of time and money.
Even the best refresher is not exempt from the law of diminishing returns, the courses steadily waning in utility and interest fairly quickly.
Isn't it time to re-think re-certification?
Isn't it, perhaps, time to re-think licensure, so that, like our RN counterparts, we can keep our jobs without enduring the mind-numbing burden every other year of a 48-hour re-hashing of things we already do every day?
I hope so.
And Free The Massachusetts 200!

Not A Purely Hypothetical Question

Ok, so this is something of a poll question. I'd love to hear your responses.

Do you believe that there is such a thing as "driving too slow" when using lights and sirens?

AND,

Do you believe that, while using lights and sirens and patient loaded, it is your duty to "test the limits of the ambulance's performance?"

I sincerely want to hear your responses. This isn't a completely hypothetical question.

Medic In Need

I know this isn't a "central Massachusetts" story, but I read this story about a Paramedic battling cancer in New Hampshire and I felt like it was something I needed to spread the word about.
Sarah Fox is a 38-year-old Paramedic who has 2 1/2-year-old twins and a 7-year-old daughter.
She also has terminal cancer and has been given a year to live.
Firefighters from the Portsmouth (NH) Fire Department are selling window and helmet stickers to help defray the cost of Sarah's treatment.
I know from firsthand experience how devastating the costs of caring for a loved-one with cancer can become, and I think it's a tremendous thing that the folks from Portsmouth FD are trying to do.
I hope and pray for Ms. Fox's recovery, but I also plan on buying a few stickers to help ensure that she can spend whatever time is left enjoying her family and not worrying about expenses.
Anyone interested in buying stickers can send a check payable to "Portsmouth Firefighters Charitable Association" to Portsmouth Fire Station 1, 170 Court St., Portsmouth, NH, 03801. Helmet stickers are $5 and vehicle stickers are $10.

Demons From The Imperial City

There were moments when my patient was gone, just....gone.
At first I couldn't figure out why this 60-year-old man, apparently in terrific health, who bragged that he still pounded out the mileage every day, would from time to time squeeze his eyes tight, begin sweating profusely and whimper.
There was no connecting with him in that state.
It was as if his body was here but his spirit had traveled elsewhere.
And as fast as he left, he returned, opening his eyes as if seeing his surroundings for the first time.
I was baffled.
And then I noticed a familiar tattoo on his left biceps.
"Were you in the Marines?" I asked.
"I was."
"Me, too. Semper Fi."
We shook hands.
"I was with 2/5, in 1968," he said.
And suddenly it all made sense.
2nd Battalion, 5th Marine Regiment.
A storied unit that has done three deployments to Iraq in this latest war, 2/5 had its origins in the early days of World War I, the unit's motto -- "Retreat, Hell!" -- derived from a perhaps apocryphal quote by a Marine 2/5 officer who, when ordered to retreat during a battle in The Great War, is said to have exclaimed "Retreat? Hell, we just got here!"
Forty-one years ago, my patient's regiment greeted the new year by undergoing the onslaught of the Tet Offensive in the Vietnam War, followed in February by the door-to-door carnage of some of the war's most violent combat, the battle to take the Imperial City of Hue, fighting immortalized in the movie "Full Metal Jacket."
It was clear that when my patient's spirit left our ambulance he was returning to those bloodied streets, where he was a rifleman in one of three battalions of Marines who fought 10,000 enemy soldiers in some of the most brutal close quarter fighting of the war.
A little math gave me my patient's age at the time of the battle -- 18-years-old.
My patient wasn't particularly sick, at least not in a physical sense.
I started an IV anyway, drew some labs for the ED, placed the man on our heart monitor.
Mostly I just rested a hand on his shoulder during the worst moments, letting him know that even though I was in the Corps 20 years later and on the opposite coast, that he wasn't alone, that he had a buddy with him nonetheless.
It was one of those calls where afterwards you thank God for what you do for a living, for the rare and brief chances we get to touch, even for a moment, the sublime.
I can't imagine what it would be like to be chased by nightmares for 40 years.
I wish I had the power to bring him some peace.

Shake and Bake Disaster

I've made no bones about the fact that I think EMS is in trouble here in Massachusetts.

Until now, I've directed my opprobrium squarely at the people running the show here in the Commonwealth.

But sometimes we do it to ourselves.

An EMS "training" facility (and I use that term loooooooosely) is advertising a 20-day EMT-Basic course.

Let that sink in for a bit.

20 days.

Not even a month.

Not even 75 percent of a month.

How many other states in this country can you be, say, waiting tables at a Chili's today and in less than three weeks be listening to lung sounds?

Worse still, if the Powers That Be in Boston have their way, that same EMT graduate of almost 21 days of hard training will also insert an advanced, invasive airway device like the King LT.

It's a Shake and Bake disaster waiting to happen.

20 days....advanced airway devices.....some days it's enough to make me want to do something else for a living, and remove the numbers "9" and "1" from the phones of people I love.

Epi-cally Stupid

I'm going to make this short and sweet because I've got other things to do, and if I let myself go I'll rant for hours and hours.

Consider this an open letter to Massachusetts OEMS:

Dear Sirs/Madams:

I understand that Paramedics in Massachusetts are no longer allowed to draw up their own initial doses of Epi 1:1,000 nor administer them with traditional SQ/IM techniques, but instead must use EpiPens. I also understand that while we can still draw up our own follow-up doses, we must first contact Medical Control and get a Physician's permission.

From the scuttlebutt amongst us lowly providers, this is the result of a half-dozen to a dozen (depending on who's telling the story) instances where paramedics (who don't deserve capitalization in this case) have mistakenly administered said 1:1,000 through a peripheral IV, with adverse outcomes.

My question is two-fold:

1 -- why are you restricting the practice of all Paramedics, 99.9 percent of whom DID NOT make this error?

2 -- why are the 12 or so IDIOTS who did make this life-threatening mistake still allowed to work in Massachusetts?

Wouldn't it make more sense to re-educate or de-certify the offenders rather than dumb-down an entire profession?

Did anyone also consider what this means for our patients, who will now have to suffer the consequences of both paramedic blunder and bureaucratic overkill?

Having had injections by SQ/IM and autoinjector, I can tell you that a properly administered SQ/IM injection is FAR LESS painful than the spring-loaded delights we now must jam into our patients.

I implore you to undo this rule change and aim your sights instead on the knuckleheads who deserve it.

Thank you.

CMM

Primary Source

I post this item below for no particular reason other than it made me chuckle. A couple years ago a buddy of mine who works as a cath lab RN asked me what a typical night was like in The Big City.

While searching my email account for something else today I found my answer, archived for posterity by the fine folks at Yahoo Mail.

It gave me a chuckle. I left MegaHospital EMS not even a year ago but already I'd started becoming nostalgic for the job.

Not every shift involved so many inebriated or sad patients, but every shift involved at least a few of each.

This email was a nice reminder that it wasn't all wine and roses.

When you read this, keep in mind that there are guys and gals who've lived like this for 10, 15, even 20+ years, and yet are able to practice Paramedicine at a high level.

My hat's off to them. I can't think of many tougher ways to make a living!

"So it's almost 3 a.m., which is when my shift ends.

Here's what tonight was like for me at [MegaHospital EMS]:

Arrive at 5 pm, get narc keys, radio and perform quick check of truck.

Attempt to get dinner but am immediately sent out to pick up a drunk instead.

Try to get dinner three more times but am sent out for two drunks and a psych.

Eat cold, slimy slice of what I think is spinach and feta pizza at Worcester Med.

Listen as two other trucks get sent out on a code and pedi respiratory arrest.

I do LB instead, the world's most notorious drunk.

Watch four minutes of the Red Sox, go for the psych.

Then get sent to a code that turns out to be a long-dead drug dealer (complete with video camera monitoring system of his entire street) who sampled too many of his own wares.

Spend 45 minutes there, get to enjoy full metal familial meltdown when the dead guy's entire family shows up to profess their grief at 1,000 decibels, although judging from the pharmaceutical paraphernalia and stacks of cash being inventoried by the cops, this outcome can hardly have been a surprise.

Go out for two more drunks.

Try to get midnight snack, instead help an attractive, 18-year-old mildly drunk girl into her brother's car for a ride back to the 'burbs and the comfort of mommy and daddy's glorious McMansion.

She grabs my ass twice and pukes on my boots, so kind of a mixed blessing there.

We then take a well-known psych who's hearing voices that seem to sound EXACTLY like mine, then win the Double Jeopardy round by getting sent out for the person both drunk AND psych.

Top off the shift by breaking up a fight in the middle of Main Street between two drunk personages of Caribbean descent apparently angry with each other's driving habits.

Dinner never achieved.

Currently 42 hours with less than 4 hours sleep total.

Total caloric intake: One slimy piece of pizza, species unknown, believed to be vegetable. One Baby Ruth. One Snickers. Seven cans Diet Coke. One oatmeal creme cookie. Four Graham crackers and a jello stolen from the nourishment center at [MegaHosptal].

I come for the glory, I stay for the pampering........"

Slouching Toward Mediocrity

So we finally got Solu-Medrol on the ambulances here in Massachusetts.

It's a drug I used often in Connecticut once upon a time, to excellent effect on a variety of respiratory ailments. I don't care what the experts say, I've seen Solu-Medrol work its magic in under 10 minutes, and have always felt it was a missing piece in the Mass Paramedic armamentarium.

So now we have it.

This being Massachusetts, though, that sound you're hearing is the deafening shriek of someone standing on the brakes.

Why?

Here is the list of approved uses for Solu-Medrol, according to the most recent Statewide Treatment Protocols (Official Version # 8.03, Effective 3/1/2010) --

Anaphylaxis, asthma, spinal cord injury, croup, elevated intracranial pressure (prevention and treatment), as an adjunct to shock.

Pretty impressive, right?

Guess how many of those conditions Paramedics in Massachusetts will have the option of using Solu-Medrol to treat?

NONE. Nada. Zip.

Sadly, there is but one instance under which a Paramedic in the state of Massachusetts can call a physician and beg permission to administer Solu-Medrol: Known adrenal insufficiency.

True, Solu-Medrol can be a life-saving intervention for someone with adrenal insufficiency, where the namesake glands, located just behind the kidneys, fail to produce the cortisol and aldosterone which is critical to maintaining blood pressure, sugar and salt balance, and heart muscle tone.

Essentially the body loses its ability to handle stressors (in crisis, a normal person's adrenal glands can pump out up to 10 times their normal cortisol production; those with AI cannot), and the condition can be fatal.

Surely, for these people, having Solu-Medrol on the ambulances will be a life-saving development.

But the Office of Rare Diseases at the National Institutes of Health officially classifies adrenal insufficiency as a "rare" disease, meaning fewer than 200,000 people are affected by it.

That's 200,000 people out of a US population of about 300,000,000.

Locally, only about 3,800 people in Massachusetts have known adrenal insufficiency, or a little more than 10 people per town statewide on average.

Contrast that small patient population, for whom we have permission to treat (or, anyway, at least the permission to ask permission), to the vast population of respiratory patients who might also benefit from Solu-Medrol but who will not be afforded that opportunity.

It seems patently unfair, but I'm sure the experts have their reasons, and some day one of them may deign to enlighten the rest of us.

Until then, I'll keep scratching my head as I slouch toward the mediocrity that's being forced upon me, failing to understand the rationale behind carrying 375 mg of Solu-Medrol to treat a patient population I might see two, maybe three times in a decade, even though I see a dozen patients per week who might also benefit from the drug but to whom I must deny it.

Next Week: Epi-Pens, or, Why The State Is Punishing All Paramedics And Their Patients Instead of De-Certifying The Idiots Who Don't Know The Difference Between 1:1,000 And 1:10,000.........

19 Years.....

I wanted to take a moment to congratulate a friend of mine, Rod Witkos, for reaching a remarkable milestone -- 19 years of superior Paramedic service in one of the busiest EMS systems in the country.

To mark the occasion Rod has written on his blog, Wormtown Medic, one of the best posts I've ever read describing the state of EMS in central Massaschusetts today.

It's an unflinching look, but Rod has never been one to flinch in the face of some unpleasant realities.

Congratulations Rod. Here's to 19 more great years.....

RIP Emerson ALS-1

One of the state's premier EMS services closed this morning, replaced by a for-profit ambulance company.

Emerson Hospital ALS-1 is no more.

As of 7 a.m. Pro EMS of Cambridge, previously most famous for carrying Cambridge FD's luggage, is now responsible for the 14-town district once served by a cadre of Paramedics who lived and worked in the area, for whom local EMS was a calling, not a revenue stream.

I'm mad.

I'm mad at the CEO of Emerson Hospital, Christine Schuster, for turning her back on a service that was for decades the hospital's best ambassador to the communities it served, and for joining the ranks of other hospital executives for whom quality prehospital care is not worth caring about enough to actually spend money on.

I'm mad that my worst fears have been confirmed -- quality care, professionalism and integrity matter not a bit in this industry. All those years of thinking that all we had to do was provide the best prehospital care we could and the rest would take care of itself, well, it turns out I wasn't completely wrong. "The rest" did in fact take care of itself, though not in the way I would have wanted.

And I'm mad at what I'm sure is a whole series of events of which I am completely unaware but which conspired to end ALS-1's run.

Thank you to all the people who made my time there such a rewarding experience, and best of luck in the future. You will be missed.

The Cost of Dying

My friend Burt sent along this clip of a recent "60 Minutes" story detailing the incredible costs of end-of-life care.

It's a compelling and provocative story, although I don't share the pessimistic view of ICU care that the piece espouses.

Still, great food for thought.



Watch CBS News Videos Online

Uncomfortable Arithmetic — Whom to Cover versus What to Cover

New in the latest issue of the New England Journal of Medicine, a couple PhDs with Harvard credentials admit that no matter what health care reform looks like, the money isn't unlimited.

The government won't be able to cover everyone for everything.

"[E]ventually, we will have to engage in the difficult discussions required to choose whom and what our public insurance programs should cover," the authors admit near the end of the article. "Some might call this rationing, but the reality is that millions of Americans now have no access to lifesaving medical technologies at the same time that public resources are being devoted to covering less-effective therapies for less-serious conditions. We find that sort of rationing hard to justify."

Interesting article, if only for its honesty.

Read it here:

Uncomfortable Arithmetic — Whom to Cover versus What to Cover

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America

Still obsessed with health care reform, still feel like a babe lost in the woods when it comes to the details.

The New England Journal of Medicine has been a great source of many interesting articles on the subject, and I've linked to one of the more recent, excellent examples below.

There's a grim case study in the article about Atlanta's Grady Hospital that had to shut down its dialysis unit after losing upwards of $50,000 per uninsured patient per year.

I think more frontline providers in EMS need to pay attention. Ultimately we're the ones that will bear the burdens of whatever chaos the bureaucrats and politicians wreak.

America’s Safety Net and Health Care Reform — What Lies Ahead?

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Cleveland Rocks!

Maybe it's a sign of things to come.

Maybe Cleveland is just the first EMS system to admit officially that 911 has become a farce.

Either way, I agree with this post on the Happy Medic blog lauding a report in the Cleveland Plain Dealer regarding Cleveland EMS's decision to refuse priority service on nonsense.

The plan instead seems to be to hold toe pains and VNA referrals for patients with UTIs until enough units are in service so that a cardiac arrest doesn't get a delayed response while everyone else is tied up driving sad people all over Kingdom Come.

Like everything else in our industry, it may be a laudable plan but it's mainly been chosen because a lack of money dictates it.

Maybe someday EMS decision-makers will make the right calls based solely on their rightness.

For now, money will have to do.

A Gap In The Thin Blue Line

When I was hired as a medic in The Big City, one of the first things the veterans told you was that we had an incredibly close relationship with the WPD.
Solidified over decades working side-by-side with Worcester's thin blue line, one of the biggest responsibilities we new guys had, outside of patient care, was to NOT screw that relationship up.
WPD officers were to be treated as our own, and if, God forbid, one of them were to be hurt on our watch, we were expected to move Heaven and Earth to care for them.
It didn't take long on those city streets to understand why.
Simply put, the men and women of the WPD are the best cops around.
They watched our backs and were a big reason working in The Big City was once one of the best paramedic jobs anywhere.
Officer Mark Bisnette was among the best officers on a department full of great officers.
A brother Marine, Biz was one of those officers who always seemed to have a smile on his face and a little time to shoot the breeze with the ambulance crews.
In a city chock full of people who get off on antagonizing the police, I never saw Biz have a bad word for anybody.
I've always been amazed by the way WPD officers defuse potentially violent situations on a daily basis without resorting to violence.
To me, that's got to be on the list of things that differentiates great cops from average ones.
WPD officers always know the players on their routes, always seem to have a great feel for street-level human psychology and motivations, and clearly know how to put this knowledge to use keeping the city safe.
I think this combination of attributes explains why officer-involved shootings in Worcester are incredibly rare.
People who possess this ability are equally rare, and Biz definitely had it in spades.
It's just one of the many reasons he will be missed.
Worcester Police Officer Mark Bisnette, 38, was off-duty early Saturday morning when he was killed in a single-car accident in a nearby suburb.
He leaves a wife and four children.
RIP Biz. You are one of the best.