Just wanted to include a link to an awesome prehospital cardiology blog.
Comprehensive, well-written, immediately useful.
I can't ask for much more.
Keynote
1 month ago
Thursday, December 25, 2008
Just Another Day
To those of you who.......
...are far from your families in order that my family might be safe
...ate cold ham and fixings today provided by people with warm hearts in an ambulance garage or day room or nurse's station
...drove across cities and towns and back country roads to calamities great and small today under flashing lights while the rest of us watched our kids vroom Tonka ambulances and fire trucks across the living room floor
...know what it's like to deal with frequent fliers who also didn't take the day off
...get the job done day in and day out, but especially on days like today....
Merry Christmas, and THANK YOU.
...are far from your families in order that my family might be safe
...ate cold ham and fixings today provided by people with warm hearts in an ambulance garage or day room or nurse's station
...drove across cities and towns and back country roads to calamities great and small today under flashing lights while the rest of us watched our kids vroom Tonka ambulances and fire trucks across the living room floor
...know what it's like to deal with frequent fliers who also didn't take the day off
...get the job done day in and day out, but especially on days like today....
Merry Christmas, and THANK YOU.
Monday, December 22, 2008
...and I'll Tell You No Lies.
4 a.m., the home stretch of one of the busiest shifts I've ever done in a normally quiet suburban town we cover.
The dispatcher tells us the guy who called complaining of shortness of breath seemed anxious, and when we get there I realize anxious is an understatement.
He meets us at the door, and the moment we open it a crack he jogs into a living room down the hall and drops into a couch.
He can't or won't sit still.
"I've been having trouble breathing since midnight," he says."I had some chest pain earlier but it's gone now."
His history is textbook train wreck: mid-50s, lifelong smoker, diabetic/hypertensive with coronary artery disease and a stupendous case of the high-lows: everything that should be high is low and everything that should be low is high.
The more we talk to him the more agitated he gets.
We try putting a nonrebreather on him but he tears it off every time, maybe from hypoxia, maybe from claustrophobia. He accepts a nasal cannula, but barely.
He looks sick, and my partner and I move a step faster than normal, believing we may be headed to the cath lab.
So here's where I need to take a moment to debunk an EMS myth of my own.
The myth goes like this: any time a patient tells you they're going to die, believe them.
Well, that makes for a nice truism, but I've found that the ratio is something like 1 in 100 people who tell me they're about to die that actually go ahead and give it a shot.
Mostly, patients who tell me they're going to die are responding to a mix of anxiety and dyspnea, and almost all the time we're able to deliver them to the hospital without a problem.
But there are exceptions.
Back to the living room:
In the midst of the usual hurly-burly that goes into treating a patient like this, I was finishing up applying electrodes to the patient's chest for a 12-lead EKG when he became eerily calm and grabbed my arm.
He looked right into my eyes and said, with all the stress of placing an order for a medium regular at Dunkin' Donuts:
"I'm going to die."
I tried to be reassuring while still managing to get the EKG done.
"No, I'm going to die," he said again.
The 12-lead showed that the patient was suffering from an anteroseptal STEMI, but his vitals were good and he had a strong radial pulse at 80, matched by a similar rate on the monitor, so my partner and I figured we were in good shape to get him to the cath lab less than 5 miles away.
Then, in an instant, the patient died.
He went from 80 and normal sinus on the monitor to pulseless and asystolic in the space of about 10 seconds: do not stop, do not pass VTach or VFib, go straight to nothing.
It was like turning off a light switch.
We fought as hard as we could for the patient, but nothing we did had any effect, and he was pronounced dead not long after we got to the hospital.
There was no one to tell. The man lived alone and left no list of contacts or next-of-kin for anyone to locate.
I know the police were trying to track down rumors of a sister elsewhere in the state.
Sometimes patients will do what they say they're going to do, no matter how hard you work to fix them.
A lot of our patients lie to us, try to convince us they're not sick when they are, or that they're sick when clearly they are not.
And sometimes, there are patients who tell you no lies, and you remember them probably forever, and at the very least for a long time.
The dispatcher tells us the guy who called complaining of shortness of breath seemed anxious, and when we get there I realize anxious is an understatement.
He meets us at the door, and the moment we open it a crack he jogs into a living room down the hall and drops into a couch.
He can't or won't sit still.
"I've been having trouble breathing since midnight," he says."I had some chest pain earlier but it's gone now."
His history is textbook train wreck: mid-50s, lifelong smoker, diabetic/hypertensive with coronary artery disease and a stupendous case of the high-lows: everything that should be high is low and everything that should be low is high.
The more we talk to him the more agitated he gets.
We try putting a nonrebreather on him but he tears it off every time, maybe from hypoxia, maybe from claustrophobia. He accepts a nasal cannula, but barely.
He looks sick, and my partner and I move a step faster than normal, believing we may be headed to the cath lab.
So here's where I need to take a moment to debunk an EMS myth of my own.
The myth goes like this: any time a patient tells you they're going to die, believe them.
Well, that makes for a nice truism, but I've found that the ratio is something like 1 in 100 people who tell me they're about to die that actually go ahead and give it a shot.
Mostly, patients who tell me they're going to die are responding to a mix of anxiety and dyspnea, and almost all the time we're able to deliver them to the hospital without a problem.
But there are exceptions.
Back to the living room:
In the midst of the usual hurly-burly that goes into treating a patient like this, I was finishing up applying electrodes to the patient's chest for a 12-lead EKG when he became eerily calm and grabbed my arm.
He looked right into my eyes and said, with all the stress of placing an order for a medium regular at Dunkin' Donuts:
"I'm going to die."
I tried to be reassuring while still managing to get the EKG done.
"No, I'm going to die," he said again.
The 12-lead showed that the patient was suffering from an anteroseptal STEMI, but his vitals were good and he had a strong radial pulse at 80, matched by a similar rate on the monitor, so my partner and I figured we were in good shape to get him to the cath lab less than 5 miles away.
Then, in an instant, the patient died.
He went from 80 and normal sinus on the monitor to pulseless and asystolic in the space of about 10 seconds: do not stop, do not pass VTach or VFib, go straight to nothing.
It was like turning off a light switch.
We fought as hard as we could for the patient, but nothing we did had any effect, and he was pronounced dead not long after we got to the hospital.
There was no one to tell. The man lived alone and left no list of contacts or next-of-kin for anyone to locate.
I know the police were trying to track down rumors of a sister elsewhere in the state.
Sometimes patients will do what they say they're going to do, no matter how hard you work to fix them.
A lot of our patients lie to us, try to convince us they're not sick when they are, or that they're sick when clearly they are not.
And sometimes, there are patients who tell you no lies, and you remember them probably forever, and at the very least for a long time.
Wednesday, December 17, 2008
Questioning the Sacred Cow
Anyone who follows the writing of emergency physician and author Dr. Bryan Bledsoe knows that he's not afraid to challenge many of the things we take for granted in EMS.
Among other things, he has in the past been critical of what he sees as the overuse of air medical transports, has wondered not only about the usefulness of CISD, but also questioned whether the process actually increases the psychological trauma of high-stress incidents.
He has a really interesting article on JEMS.com right now outlining a series of studies that jibe with Dr. Bledsoe's distrust of the sacred cow.
His thought-provoking column is a round up of studies, some of which have been inexplicably ignored in the US for over a decade, like the one comparing neurological outcomes in trauma patients between Albequerque, where aggressive c-spine immobilization is the norm, and Malaysia, where c-spine immobilization is unheard of.
Interestingly, the study found that the neurological outcomes in Malaysia were better.
This study was published in 1998, and yet we continue to strap thousands of people a year to hard plastic boards without a second thought.
Other studies Dr. Bledsoe highlights include one that suggests IV epi is of little use in cardiac arrests and another that proposes using D10 for acute hypoglycemics versus D50.
Check out the column, I don't think you'll be disappointed.
Among other things, he has in the past been critical of what he sees as the overuse of air medical transports, has wondered not only about the usefulness of CISD, but also questioned whether the process actually increases the psychological trauma of high-stress incidents.
He has a really interesting article on JEMS.com right now outlining a series of studies that jibe with Dr. Bledsoe's distrust of the sacred cow.
His thought-provoking column is a round up of studies, some of which have been inexplicably ignored in the US for over a decade, like the one comparing neurological outcomes in trauma patients between Albequerque, where aggressive c-spine immobilization is the norm, and Malaysia, where c-spine immobilization is unheard of.
Interestingly, the study found that the neurological outcomes in Malaysia were better.
This study was published in 1998, and yet we continue to strap thousands of people a year to hard plastic boards without a second thought.
Other studies Dr. Bledsoe highlights include one that suggests IV epi is of little use in cardiac arrests and another that proposes using D10 for acute hypoglycemics versus D50.
Check out the column, I don't think you'll be disappointed.
Wednesday, November 12, 2008
EMS Longevity
Work EMS for any length of time and you're bound to eventually question whether you've got the stamina to make a career of it.
We all know the challenges.
It was refreshing, therefore, to read this article by a guy who's been doing EMS for 24 years in North Carolina.
I hope when I've been doing it that long that I'll be half as optimistic as the column's author, Robert Powers.
I don't see why not.
I look at the ways EMS has improved since I worked my first shift as a Basic at MedTrans in 1995.
The field is dramatically better in almost every respect, and I have no reason to expect that this won't continue.
Like I tell myself whenever I respond to the wet shelter in The Big City for the fourth or fifth time in a shift -- this job may be hard, but it still beats working for a living...
We all know the challenges.
It was refreshing, therefore, to read this article by a guy who's been doing EMS for 24 years in North Carolina.
I hope when I've been doing it that long that I'll be half as optimistic as the column's author, Robert Powers.
I don't see why not.
I look at the ways EMS has improved since I worked my first shift as a Basic at MedTrans in 1995.
The field is dramatically better in almost every respect, and I have no reason to expect that this won't continue.
Like I tell myself whenever I respond to the wet shelter in The Big City for the fourth or fifth time in a shift -- this job may be hard, but it still beats working for a living...
Wednesday, November 5, 2008
An Easy Change
Change is hard.
I had an official from the Boston headquarters of the DCR tell me that once when I complained about a parking lot he was putting in my front yard.
This official was the worst kind of government hack, and I hope they move the PIP to his backyard.
But he had a good point.
Change is hard or, rather, can be hard, if you're not prepared for it.
I've written here before about the changes at Spencer Rescue, which under the guidance of its leadership has transformed itself almost overnight (at least in glacial EMS terms) into one of central Massachusetts' best EMS agencies and a place where good medics want to work.
Most of that change took place under the watchful eye of Keith Ventimiglia, the service's former clinical supervisor.
Keith has since moved on to tackle a very interesting project that I look forward to writing about here in the future.
Hired to continue the progress made under Ventimiglia's watch is Dominic Singh, who recently took over Keith's position at Spencer Rescue.
Dom, 31, is an immensely likable and talented paramedic, and in the interest of full disclosure I should admit that Dom and I worked together for several years in The Big City and he is a friend of mine, so objectivity is out the window on this one. Personal feelings aside, Dom has earned his reputation the way all good medics do it -- one shift at a time, year in and year out.
A native of the Merrimack Valley, Dom graduated from Andover High School in 1995 and received a B.A. in Chemistry from The College of the Holy Cross in Worcester. It was during his studies there in 1997 that Dom got his EMT card and went to work for both Patriot Ambulance and the Stow Fire Department. After graduating Dom attended the Quinsigamond Community College Paramedic Program.
In addition to Spencer Rescue, Dom is a career Firefighter/Paramedic with the Amherst (Mass.) Fire Department and was until recently a Paramedic for UMassMemorial/Worcester EMS.
Dom lives in Amherst with his wife and three kids: Matthew, 4; Eden, 2; Ezekiel, 1.
In an email exchange with CMM, Dom was kind enough to talk a little about his new position, Spencer Rescue, and EMS in general.
CMM: EMS is a challenging field, particularly for those working to improve the product, so to speak. What do you see as the main challenge facing QA/QI programs in general, and at Spencer Rescue specifically?
DS: The main challenge that any QA/QI program faces is learning to cater the feedback to your crews, so as to promote growth, learning and better patient care without creating a feeling of alienation or condemnation.
A lot of places start out with the best of intentions, but end up creating an adversarial relationship with the crews, or review so infrequently that too much is missed.
The challenge in Spencer is to cater the program to the wide range of experience and certification levels.
The personnel here range from 20-year medics to basics just out of school. The initiation of the new employe during his or her formative years is just as important as making sure a senior member is current on the latest advanced modalities.
As long as the employee can be encouraged to buy into the program and the administrator keeps the reviews honest and level, it should succeed.
CMM: Spencer Rescue has undergone a remarkable transformation in a relatively short period of time. What has allowed the service to make such strides, and do you think such progress is sustainable?
DS: Spencer EMS has undergone some rather radical advancement over the last several years which were primarily the result of Keith Ventimiglia's leadership. He had a vision of where the agency should be headed, and facilitated that by bringing in a few reliable and reputable providers, as well as updating equipment, policies, and introducing some leading-edge therapies (e.g., CPAP).
I believe this type of change is sustainable as long as each small step on the way is planned, carefully executed, and has the buy-in of the crew members. While administration can choose a course, it will never be properly received without the backing of the providers.
CMM: Spencer Rescue is a third-service, non-profit agency that serves the Town of Spencer. What advantages do you see to this model, particularly in the western part of central Mass, where there aren't necessarily the resources in money and personnel you might find closer to Boston? Any disadvantages?
DS: Unlike some other third-services or fire-based EMS, we don't receive any funding from the town. All the monies collected from transports go entirely back into the agency.
I believe it does truly change the attitude of the crews if they think that their skills and hard work are being used to line the pockets of a distant owner, or all the money is being thrown into a town budget and distributed to other agencies.
Each dollar we make is in some way being used to assist people. I personally find this motivating, and it was a major in my decision to accept this current position. I'm truly working to heolp people and maintain a healthy environment for providers of a like mind.
We even allow the citizens of our service area the opportunity to buy-in to the agency with our subscription drive. It pays for itself in one transport, and offers a little bit of ownership in our end goal. [Residents] know that those dollars are going directly to this specific agency, unlike your taxes.
Our only disadvantage with this system comes from some people's view that, because we are not a "town department," we don't have their best interests in mind. Nothing could be further from the truth.
CMM: What's on the horizon for Spencer Rescue? Any new initiatives or changes you can talk about?
DS: We're currently accepting sketches for a new patch design, possibly a couple changes to the uniform.
We're also investing in new outerwear and PPE for all department members.
My plan is to invest in our crews as much as they invest in us. There are definitely other plans in the works, but nothing I want to roll out in this forum. Sorry!
CMM: What was it about Spencer Rescue that first appealed to you, and what advice would you have to leaders of similar services about setting and achieving clinical goals?
DS: Spencer actually came to me. Keith contacted me to come in and fill some shifts. After checking it out for a while, I saw the unique model Spencer operates under and how this is truly the core structure I had been searching for. I also saw the potential this place had and wanted to be a part of its rise to that potential.
The only advice that I hve is to keep your crews involved.
If the crews don't buy-in then you're doomed to fail.
I had an official from the Boston headquarters of the DCR tell me that once when I complained about a parking lot he was putting in my front yard.
This official was the worst kind of government hack, and I hope they move the PIP to his backyard.
But he had a good point.
Change is hard or, rather, can be hard, if you're not prepared for it.
I've written here before about the changes at Spencer Rescue, which under the guidance of its leadership has transformed itself almost overnight (at least in glacial EMS terms) into one of central Massachusetts' best EMS agencies and a place where good medics want to work.
Most of that change took place under the watchful eye of Keith Ventimiglia, the service's former clinical supervisor.
Keith has since moved on to tackle a very interesting project that I look forward to writing about here in the future.
Hired to continue the progress made under Ventimiglia's watch is Dominic Singh, who recently took over Keith's position at Spencer Rescue.
Dom, 31, is an immensely likable and talented paramedic, and in the interest of full disclosure I should admit that Dom and I worked together for several years in The Big City and he is a friend of mine, so objectivity is out the window on this one. Personal feelings aside, Dom has earned his reputation the way all good medics do it -- one shift at a time, year in and year out.
A native of the Merrimack Valley, Dom graduated from Andover High School in 1995 and received a B.A. in Chemistry from The College of the Holy Cross in Worcester. It was during his studies there in 1997 that Dom got his EMT card and went to work for both Patriot Ambulance and the Stow Fire Department. After graduating Dom attended the Quinsigamond Community College Paramedic Program.
In addition to Spencer Rescue, Dom is a career Firefighter/Paramedic with the Amherst (Mass.) Fire Department and was until recently a Paramedic for UMassMemorial/Worcester EMS.
Dom lives in Amherst with his wife and three kids: Matthew, 4; Eden, 2; Ezekiel, 1.
In an email exchange with CMM, Dom was kind enough to talk a little about his new position, Spencer Rescue, and EMS in general.
CMM: EMS is a challenging field, particularly for those working to improve the product, so to speak. What do you see as the main challenge facing QA/QI programs in general, and at Spencer Rescue specifically?
DS: The main challenge that any QA/QI program faces is learning to cater the feedback to your crews, so as to promote growth, learning and better patient care without creating a feeling of alienation or condemnation.
A lot of places start out with the best of intentions, but end up creating an adversarial relationship with the crews, or review so infrequently that too much is missed.
The challenge in Spencer is to cater the program to the wide range of experience and certification levels.
The personnel here range from 20-year medics to basics just out of school. The initiation of the new employe during his or her formative years is just as important as making sure a senior member is current on the latest advanced modalities.
As long as the employee can be encouraged to buy into the program and the administrator keeps the reviews honest and level, it should succeed.
CMM: Spencer Rescue has undergone a remarkable transformation in a relatively short period of time. What has allowed the service to make such strides, and do you think such progress is sustainable?
DS: Spencer EMS has undergone some rather radical advancement over the last several years which were primarily the result of Keith Ventimiglia's leadership. He had a vision of where the agency should be headed, and facilitated that by bringing in a few reliable and reputable providers, as well as updating equipment, policies, and introducing some leading-edge therapies (e.g., CPAP).
I believe this type of change is sustainable as long as each small step on the way is planned, carefully executed, and has the buy-in of the crew members. While administration can choose a course, it will never be properly received without the backing of the providers.
CMM: Spencer Rescue is a third-service, non-profit agency that serves the Town of Spencer. What advantages do you see to this model, particularly in the western part of central Mass, where there aren't necessarily the resources in money and personnel you might find closer to Boston? Any disadvantages?
DS: Unlike some other third-services or fire-based EMS, we don't receive any funding from the town. All the monies collected from transports go entirely back into the agency.
I believe it does truly change the attitude of the crews if they think that their skills and hard work are being used to line the pockets of a distant owner, or all the money is being thrown into a town budget and distributed to other agencies.
Each dollar we make is in some way being used to assist people. I personally find this motivating, and it was a major in my decision to accept this current position. I'm truly working to heolp people and maintain a healthy environment for providers of a like mind.
We even allow the citizens of our service area the opportunity to buy-in to the agency with our subscription drive. It pays for itself in one transport, and offers a little bit of ownership in our end goal. [Residents] know that those dollars are going directly to this specific agency, unlike your taxes.
Our only disadvantage with this system comes from some people's view that, because we are not a "town department," we don't have their best interests in mind. Nothing could be further from the truth.
CMM: What's on the horizon for Spencer Rescue? Any new initiatives or changes you can talk about?
DS: We're currently accepting sketches for a new patch design, possibly a couple changes to the uniform.
We're also investing in new outerwear and PPE for all department members.
My plan is to invest in our crews as much as they invest in us. There are definitely other plans in the works, but nothing I want to roll out in this forum. Sorry!
CMM: What was it about Spencer Rescue that first appealed to you, and what advice would you have to leaders of similar services about setting and achieving clinical goals?
DS: Spencer actually came to me. Keith contacted me to come in and fill some shifts. After checking it out for a while, I saw the unique model Spencer operates under and how this is truly the core structure I had been searching for. I also saw the potential this place had and wanted to be a part of its rise to that potential.
The only advice that I hve is to keep your crews involved.
If the crews don't buy-in then you're doomed to fail.
Saturday, November 1, 2008
Another podcast
Just wanted a quick note to plug SurgeryICUrounds.com.
It's another site with a collection of awesome lectures, most less than an hour long, touching on some current topics in critical care medicine.
The site has some great information that is applicable to all venues of EMS, not just critical care.
Recent topics have included lectures on crush injuries and rhabdomyolysis, a two-part overview of MIs and their management (particularly thrombolytics and PCI centers), abdominal compartment syndrome (that one's for you Dr. Restuccia; I'll never forget sweating my way through the compartment sydrome question on your infamous written exam), and the philosophy and methodology of pain control.
The lectures can be downloaded to an mp3 device, or simply audio-streamed directly from the Web site.
It's another site with a collection of awesome lectures, most less than an hour long, touching on some current topics in critical care medicine.
The site has some great information that is applicable to all venues of EMS, not just critical care.
Recent topics have included lectures on crush injuries and rhabdomyolysis, a two-part overview of MIs and their management (particularly thrombolytics and PCI centers), abdominal compartment syndrome (that one's for you Dr. Restuccia; I'll never forget sweating my way through the compartment sydrome question on your infamous written exam), and the philosophy and methodology of pain control.
The lectures can be downloaded to an mp3 device, or simply audio-streamed directly from the Web site.
Urban Inspiration
As you all know, one of my favorite blogs out there is Rescuing Providence, written by Mike Morse, a lieutenant on the Providence (RI) Fire Department, where he works on one of the country's busiest ambulances.
I especially liked his latest post, which I've linked here.
It made me think of all the times where an extra moment to take a closer look at my patient as a person has reaped amazing rewards.
I've been blessed to serve Holocaust survivors and war heroes, Gold Glove boxers and a novelist or two, General Patton's driver from WWII, long-forgotten celebrities and, once, a woman who was raised in the Philippines practically as a member of General Douglas "I Shall Return" MacArthur's family, and who went to elementary school with the children of Dwight Eisenhower, one of the most important figures in U.S. history.
These were interesting people and I am a better person for having met them.
They are proof positive that beneath the surface of some of these silly EMS calls we go on there occasionally lies gold.
I especially liked his latest post, which I've linked here.
It made me think of all the times where an extra moment to take a closer look at my patient as a person has reaped amazing rewards.
I've been blessed to serve Holocaust survivors and war heroes, Gold Glove boxers and a novelist or two, General Patton's driver from WWII, long-forgotten celebrities and, once, a woman who was raised in the Philippines practically as a member of General Douglas "I Shall Return" MacArthur's family, and who went to elementary school with the children of Dwight Eisenhower, one of the most important figures in U.S. history.
These were interesting people and I am a better person for having met them.
They are proof positive that beneath the surface of some of these silly EMS calls we go on there occasionally lies gold.
Thursday, October 30, 2008
Silent Night, Random Night
It wasn't something that happens in The Big City often.
I think the last time I pulled it off was almost three years ago.
We pulled a no-hitter on an eight-hour overnight.
Nada-for-eight.
Eight up, eight down.
If last night were a soccer match, the score would be 0-0.
I'm back in tonight, and I'm expecting a loooonnngggg night.
That's the way it goes, right?
Last night was bliss, tonight should be bedlam.
Which got me to thinking about the idea of randomness.
Personally, I don't think it exists.
Theoretically, EMS shifts should follow a uniform distribution, where the chances of a call or no call during a given time period (in my case, an eight hour shift) is drawn from a single pool of chances, all of which are equally probable.
Or something like that.
Seems some guys way smarter than me agree.
True randomness is hard to generate, even when you want to, and even when you've designed a computer to achieve it.
The folks at Random.org bemoan this lack of true randomnity (is that even a word?).
"Surprising as it may seem, it is difficult to get a computer to do something by chance," says the Web site. "A computer follows its instructions blindly and is therefore completely predictable. A computer that doesn't follow its instructions in this manner is broken."
Of course, those of us who've spent any time having meals and sleep interrupted by the machinations of the EMS Gods could tell you that there's nothing random about our profession.
For me it all comes down to the statistical concept of frequency distribution.
Frequency distribution is used to illuminate data by providing a visual representation of particular occurrences and how often they occur.
Usually this data is presented in tabular form.
EMS could best be summarized by what's known as a "continuous" frequency distribution, which is used to present data on a theoretically infinite number of possible values.
It seems fitting because there are, for now, an infinite number of EMS calls yet to be.
Tonight, I expect one of those nights that feels like there are an infinite number of EMS calls yet to be.
Hopefully I'm wrong.
The answer might be in the stars, but personally I think it's in a few thousand Capes, triple deckers, nightclubs, homeless shelters and apartment complexes.
I'll let you know how it went.
I think the last time I pulled it off was almost three years ago.
We pulled a no-hitter on an eight-hour overnight.
Nada-for-eight.
Eight up, eight down.
If last night were a soccer match, the score would be 0-0.
I'm back in tonight, and I'm expecting a loooonnngggg night.
That's the way it goes, right?
Last night was bliss, tonight should be bedlam.
Which got me to thinking about the idea of randomness.
Personally, I don't think it exists.
Theoretically, EMS shifts should follow a uniform distribution, where the chances of a call or no call during a given time period (in my case, an eight hour shift) is drawn from a single pool of chances, all of which are equally probable.
Or something like that.
Seems some guys way smarter than me agree.
True randomness is hard to generate, even when you want to, and even when you've designed a computer to achieve it.
The folks at Random.org bemoan this lack of true randomnity (is that even a word?).
"Surprising as it may seem, it is difficult to get a computer to do something by chance," says the Web site. "A computer follows its instructions blindly and is therefore completely predictable. A computer that doesn't follow its instructions in this manner is broken."
Of course, those of us who've spent any time having meals and sleep interrupted by the machinations of the EMS Gods could tell you that there's nothing random about our profession.
For me it all comes down to the statistical concept of frequency distribution.
Frequency distribution is used to illuminate data by providing a visual representation of particular occurrences and how often they occur.
Usually this data is presented in tabular form.
EMS could best be summarized by what's known as a "continuous" frequency distribution, which is used to present data on a theoretically infinite number of possible values.
It seems fitting because there are, for now, an infinite number of EMS calls yet to be.
Tonight, I expect one of those nights that feels like there are an infinite number of EMS calls yet to be.
Hopefully I'm wrong.
The answer might be in the stars, but personally I think it's in a few thousand Capes, triple deckers, nightclubs, homeless shelters and apartment complexes.
I'll let you know how it went.
Thursday, October 16, 2008
A Friend of Ours...
Depending on the day I'm having, I either thank my grandmother or blame her for my career.
Either way, she's a big reason I do what I do for a living.
When I was 4-years-old, Nana brought me to a firehouse in Concord, New Hampshire.
I don't remember which one, but I still have the photo she took of me standing on the tailboard of an engine, proudly wearing a firefighter's helmet, with the number "9" on the shield.
I remember watching episodes of Emergency! on her family room floor, and the time she bought me a headlamp from LL Bean that you wore on your head because I thought it was something Paramedics Gage and DeSoto would wear.
I also remember going out with her on her little skiff into Maine's Casco Bay near Bailey Island, where she had "retired," if you could call it that.
She was the least retired retired person I ever met.
She was always running exercise classes on the islands or at the nearby Naval Air Station in Brunswick, or SCUBA diving in the Caribbean with her best friend, all of which she did until she was well into her 80s.
For fun, she launched and hauled a 20-pot string of lobster traps every year, guaranteeing we always had some of the freshest Maine lobsters around whenever we visited.
Most of all, Nana taught me to appreciate the people who help us.
She was incredibly proud of what I do for a living -- incredibly proud of what WE do for a living.
Nana understood sacrifice and hard work and doing something with your life that serves a higher good, and she always had a special place in her heart for paramedics and firefighters and cops and teachers and nurses and all those people who serve our families and communities every day with little or no fanfare.
Whenever I'm fortunate enough on the job to help someone in some small way, I know that I'm pleasing my grandmother to no end.
So it saddens me to say that those of us in public safety lost a true friend this week.
Arlene Hanchett, my Nana, of Brunswick, Maine, died Monday at the age of 94.
She was a friend of ours, and will always be.
Either way, she's a big reason I do what I do for a living.
When I was 4-years-old, Nana brought me to a firehouse in Concord, New Hampshire.
I don't remember which one, but I still have the photo she took of me standing on the tailboard of an engine, proudly wearing a firefighter's helmet, with the number "9" on the shield.
I remember watching episodes of Emergency! on her family room floor, and the time she bought me a headlamp from LL Bean that you wore on your head because I thought it was something Paramedics Gage and DeSoto would wear.
I also remember going out with her on her little skiff into Maine's Casco Bay near Bailey Island, where she had "retired," if you could call it that.
She was the least retired retired person I ever met.
She was always running exercise classes on the islands or at the nearby Naval Air Station in Brunswick, or SCUBA diving in the Caribbean with her best friend, all of which she did until she was well into her 80s.
For fun, she launched and hauled a 20-pot string of lobster traps every year, guaranteeing we always had some of the freshest Maine lobsters around whenever we visited.
Most of all, Nana taught me to appreciate the people who help us.
She was incredibly proud of what I do for a living -- incredibly proud of what WE do for a living.
Nana understood sacrifice and hard work and doing something with your life that serves a higher good, and she always had a special place in her heart for paramedics and firefighters and cops and teachers and nurses and all those people who serve our families and communities every day with little or no fanfare.
Whenever I'm fortunate enough on the job to help someone in some small way, I know that I'm pleasing my grandmother to no end.
So it saddens me to say that those of us in public safety lost a true friend this week.
Arlene Hanchett, my Nana, of Brunswick, Maine, died Monday at the age of 94.
She was a friend of ours, and will always be.
Sunday, September 28, 2008
Stairchair surprise, Pusware.com
It was the kind of call that can get under your skin if you let it.
5:30 a.m.
The end of a busy shift.
Every prior patient obese or beyond.
Many of them actually sick.
Dinner was a couple Big Cups and an orange soda several hours earlier.
We had flung more stairchairs that night than an assembler at the Ferno factory.
My partner and I were exhausted, and now we were standing in the living room of an elderly woman who didn't seem to like us at all.
"I don't want to go to the hospital," she said. "They make me sit and wait too long."
"Ok," I said, "but you must have wanted to go to the hospital when you called 911."
"Damn right I did! I'm in pain! My hand hurts, and I can't walk! Can't you just give me something here so I don't have to go?"
We'd had this same conversation three times by now, and it was getting a little tiresome, but this patient was of a kind that we've all had once in a while.
No matter what you suggest, the patient wants to do the opposite.
I began by offering a trip to the hospital, to which the patient responded in the negative, exasperated that we'd even brought up the idea of an ambulance ride.
So when I asked if she would then prefer to wait until Monday and follow up with her family physician, since, after all, she'd had this particular pain for a decade and it was no worse currently than normal, she became truly offended and demanded transport to the hospital.
Finally, after about 20 minutes of negotiation in the cramped back bedroom of the musty triple decker, the patient relented.
And for the umpteenth time that night, my partner and I strapped our overweight patient into a stairchair and began the long descent down three floors of twisty, dark and steep steps.
We paused at the bottom just before heading out onto the sidewalk.
I had the bottom of the chair and as I bent down to grab the handles for one last time, I felt something on the top of my head.
I looked up and noticed that the patient was sitting back in the stairchair.
"That was a kiss for you," she said. "For working so hard."
It was the kind of gesture my patients surprise me with from time to time, and another example of why this is the best job in the world.
Persiflager's Infectious Disease podcast is a great site to keep up with the latest and greatest developments in the world of infectious disease.
The link also connects you to PACID, aka Persiflagers Annotated Compendium of Infections Disease Facts, Opinion and Dogma.
It's kind of a meta-site, full of links to other pages concerning antibiotics, pathogens and diseases.
5:30 a.m.
The end of a busy shift.
Every prior patient obese or beyond.
Many of them actually sick.
Dinner was a couple Big Cups and an orange soda several hours earlier.
We had flung more stairchairs that night than an assembler at the Ferno factory.
My partner and I were exhausted, and now we were standing in the living room of an elderly woman who didn't seem to like us at all.
"I don't want to go to the hospital," she said. "They make me sit and wait too long."
"Ok," I said, "but you must have wanted to go to the hospital when you called 911."
"Damn right I did! I'm in pain! My hand hurts, and I can't walk! Can't you just give me something here so I don't have to go?"
We'd had this same conversation three times by now, and it was getting a little tiresome, but this patient was of a kind that we've all had once in a while.
No matter what you suggest, the patient wants to do the opposite.
I began by offering a trip to the hospital, to which the patient responded in the negative, exasperated that we'd even brought up the idea of an ambulance ride.
So when I asked if she would then prefer to wait until Monday and follow up with her family physician, since, after all, she'd had this particular pain for a decade and it was no worse currently than normal, she became truly offended and demanded transport to the hospital.
Finally, after about 20 minutes of negotiation in the cramped back bedroom of the musty triple decker, the patient relented.
And for the umpteenth time that night, my partner and I strapped our overweight patient into a stairchair and began the long descent down three floors of twisty, dark and steep steps.
We paused at the bottom just before heading out onto the sidewalk.
I had the bottom of the chair and as I bent down to grab the handles for one last time, I felt something on the top of my head.
I looked up and noticed that the patient was sitting back in the stairchair.
"That was a kiss for you," she said. "For working so hard."
It was the kind of gesture my patients surprise me with from time to time, and another example of why this is the best job in the world.
Persiflager's Infectious Disease podcast is a great site to keep up with the latest and greatest developments in the world of infectious disease.
The link also connects you to PACID, aka Persiflagers Annotated Compendium of Infections Disease Facts, Opinion and Dogma.
It's kind of a meta-site, full of links to other pages concerning antibiotics, pathogens and diseases.
Tuesday, September 23, 2008
Get This Book
In reading his book, Rescuing Providence, the thing that stands out most to me is Mike Morse's refusal to complain.
Not that I would blame him if he did.
A Lieutenant on the Providence (RI) Fire Department and assigned to the EMS division, the book follows Morse on a 38-hour shift in a busy urban 911 system.
The litany of calls is familiar.
The patient names may be different, but Morse could have just as easily been writing about Worcester, or Lawrence, or Lowell or a dozen other New England cities still trying to recover in the 21st century from the erosion of the 19th century manufacturing economies that were once their foundations.
What's different is that Morse obviously loves his job, and has genuine compassion for those particular patients, like the frequent fliers and drunks we all deal with, who would be much easier to hate.
He occasionally questions why he continues to work in such a busy system when relief is just a simple transfer request away.
In his book, Morse comes back with the simplest of answers -- he loves working on the ambulance.
I know Mike reads this site, so I hope he won't mind if I give his book a huge plug.
I started Rescuing Providence at 9 a.m. on a recent morning and read it in one sitting, not because it's short but because I couldn't put it down.
Along with Peter Canning's two books (Paramedic and Rescue 471), Morse's is the best I've read about EMS and I highly recommend it.
Check it out at the Paladin Press Web site , or follow the link on my blog to Morse's Rescuing Providence blog to order.
It'll be the best 22 bucks you'll spend this month.
Not that I would blame him if he did.
A Lieutenant on the Providence (RI) Fire Department and assigned to the EMS division, the book follows Morse on a 38-hour shift in a busy urban 911 system.
The litany of calls is familiar.
The patient names may be different, but Morse could have just as easily been writing about Worcester, or Lawrence, or Lowell or a dozen other New England cities still trying to recover in the 21st century from the erosion of the 19th century manufacturing economies that were once their foundations.
What's different is that Morse obviously loves his job, and has genuine compassion for those particular patients, like the frequent fliers and drunks we all deal with, who would be much easier to hate.
He occasionally questions why he continues to work in such a busy system when relief is just a simple transfer request away.
In his book, Morse comes back with the simplest of answers -- he loves working on the ambulance.
I know Mike reads this site, so I hope he won't mind if I give his book a huge plug.
I started Rescuing Providence at 9 a.m. on a recent morning and read it in one sitting, not because it's short but because I couldn't put it down.
Along with Peter Canning's two books (Paramedic and Rescue 471), Morse's is the best I've read about EMS and I highly recommend it.
Check it out at the Paladin Press Web site , or follow the link on my blog to Morse's Rescuing Providence blog to order.
It'll be the best 22 bucks you'll spend this month.
Tuesday, September 16, 2008
Better Living Through Thin-Slicing
"What does it take to be good at something in which failure is so easy, so effortless?"
The man asking the question is Atul Gawande, a surgeon at the Brigham and Women's Hospital in Boston who also happens to be a bestselling author.
The question comes from Better: A Surgeon's Notes on Performance, Gawande's 2007 rumination about what constitutes success in healthcare, especially in the face of what he describes as "daunting expectations."
Although Gawande is a surgeon, I think his book offers profound insights for anyone in healthcare in general, and EMS in particular.
According to Gawande, the hurdles between doing a job and doing it well begin with the simplest of premises.
"For one, lives are on the line. Our decisions and omissions are therefore moral in nature...In medicine, our task is to cope with illness and to enable every human being to lead a life as long and free of frailty as science will allow. These steps are often uncertain. The knowledge to be mastered is both vast and incomplete. Yet we are expected to act with swiftness and consistency...It's not only the stakes but also the complexity of performance in medicine that makes it so interesting and, at the same time, so unsettling."
I thought of Gawande's book over the weekend while I watched a trauma team work on a severely injured patient brought in by one of our other ambulances.
The patient had taken a huge fall and was in cardiac arrest when found by the ambulance crew.
As most people know, there are few events so certain to result in death as a heart stopped by some kind of blunt force trauma, like, for example, the sudden stop awaiting you at the end of a long drop.
The number of people who survive this kind of event is minuscule, yet my co-workers delivered this patient to the trauma team with a pulse and blood pressure, not to mention some grievous musculoskeletal injuries.
The trauma team did a similarly professional job, and the patient made it alive to an operating room that he never should have seen, if one were only to consider actuarial tables.
I thought of the innumerable opportunities for failure with this patient, beginning with the bystanders who heard his last moans and called 911, extending to the first responders who did their jobs with aplomb, and then, of course, my co-workers who got the patient's heart pumping again despite the odds and effects of gravity.
Gawande whittles down the challenge of medical success and performance to three core requirements -- diligence, doing right and ingenuity.
Diligence, he writes, "is the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles."
On the surface of things, this should be "an easy and minor virtue," Gawande writes. "You just pay attention, right? But it is neither. Diligence is both central to performance and fiendishly hard."
I think I know what Gawande is driving at here.
In Sunday School we called these things "sins of omission," those things that we do wrong by not doing.
But Gawande doesn't judge.
"Medicine is a fundamentally human profession. It is therefore forever troubled by human failings, failings like avarice, arrogance, insecurity, misunderstanding."
Perhaps the Gawande tenet most applicable to those of us who wander the streets daily in ambulances is ingenuity.
He considers it not a matter of intelligence, but of character.
"It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change," Gawande writes. "It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions."
Gawande admits these are difficult traits to engender, and who in EMS wouldn't agree?
We are a self-reporting profession, which means not only that the inmates occasionally run the asylum, but that only the machinations of the asylum that we allow to be seen or accidentally reveal come to light.
My favorite partners are those folks who ask themselves daily how they could do the job better.
What would EMS look like if that was a question the entire profession asked itself in earnest every day?
But then I think of the work of Malcolm Gladwell, a staff writer for The New Yorker and another bestselling author, and I think maybe it's a question we're answering all the time, even when we don't realize it.
If taken to its logical conclusion, Gladwell's book Blink:The Power of Thinking Without Thinking suggests that those of us in EMS and healthcare are constantly adding to an internal data bank of experience that we draw upon every shift.
Most busy urban systems share one common trait -- a particular pride in being able to walk into a room and know without even speaking with a patient whether they're "sick or not sick."
In observing various partners over the years in these busy systems, I'm amazed at the accuracy of their split-second assessments.
Gladwell wouldn't be.
A relatively new field of study in psychology, Gladwell says it's the brain's "adaptive unconscious" that allows for these uncannily accurate predictions based on the slimmest of evidence.
Ever wondered how that medic you work with was able to take a look at a patient and know it's a head bleed or CHF or STEMI before you've even put the first-in bag on the kitchen table?
Gladwell calls it "thin-slicing," which is "the ability of our unconscious to find patterns in situations and behavior based on very narrow slices of experience."
People who work for long periods of time in high-pressure, time-sensitive professions hone their thin-slicing skills to a razor's edge.
According to Gladwell, they have to in order to succeed.
"Thin-slicing is part of what makes the unconscious so dazzling," he writes. "But it's also what we find most problematic about rapid cognition. How is it possible to gather the necessary information for a sophisticated judgment in such a short time?"
Gladwell opines that an "automated, accelerated unconscious" processing takes over, and more often than not -- and more often, at times, than people who hashed out the same decision with lots more time and lots more data -- leads us to the right conclusion.
The man asking the question is Atul Gawande, a surgeon at the Brigham and Women's Hospital in Boston who also happens to be a bestselling author.
The question comes from Better: A Surgeon's Notes on Performance, Gawande's 2007 rumination about what constitutes success in healthcare, especially in the face of what he describes as "daunting expectations."
Although Gawande is a surgeon, I think his book offers profound insights for anyone in healthcare in general, and EMS in particular.
According to Gawande, the hurdles between doing a job and doing it well begin with the simplest of premises.
"For one, lives are on the line. Our decisions and omissions are therefore moral in nature...In medicine, our task is to cope with illness and to enable every human being to lead a life as long and free of frailty as science will allow. These steps are often uncertain. The knowledge to be mastered is both vast and incomplete. Yet we are expected to act with swiftness and consistency...It's not only the stakes but also the complexity of performance in medicine that makes it so interesting and, at the same time, so unsettling."
I thought of Gawande's book over the weekend while I watched a trauma team work on a severely injured patient brought in by one of our other ambulances.
The patient had taken a huge fall and was in cardiac arrest when found by the ambulance crew.
As most people know, there are few events so certain to result in death as a heart stopped by some kind of blunt force trauma, like, for example, the sudden stop awaiting you at the end of a long drop.
The number of people who survive this kind of event is minuscule, yet my co-workers delivered this patient to the trauma team with a pulse and blood pressure, not to mention some grievous musculoskeletal injuries.
The trauma team did a similarly professional job, and the patient made it alive to an operating room that he never should have seen, if one were only to consider actuarial tables.
I thought of the innumerable opportunities for failure with this patient, beginning with the bystanders who heard his last moans and called 911, extending to the first responders who did their jobs with aplomb, and then, of course, my co-workers who got the patient's heart pumping again despite the odds and effects of gravity.
Gawande whittles down the challenge of medical success and performance to three core requirements -- diligence, doing right and ingenuity.
Diligence, he writes, "is the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles."
On the surface of things, this should be "an easy and minor virtue," Gawande writes. "You just pay attention, right? But it is neither. Diligence is both central to performance and fiendishly hard."
I think I know what Gawande is driving at here.
In Sunday School we called these things "sins of omission," those things that we do wrong by not doing.
But Gawande doesn't judge.
"Medicine is a fundamentally human profession. It is therefore forever troubled by human failings, failings like avarice, arrogance, insecurity, misunderstanding."
Perhaps the Gawande tenet most applicable to those of us who wander the streets daily in ambulances is ingenuity.
He considers it not a matter of intelligence, but of character.
"It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change," Gawande writes. "It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions."
Gawande admits these are difficult traits to engender, and who in EMS wouldn't agree?
We are a self-reporting profession, which means not only that the inmates occasionally run the asylum, but that only the machinations of the asylum that we allow to be seen or accidentally reveal come to light.
My favorite partners are those folks who ask themselves daily how they could do the job better.
What would EMS look like if that was a question the entire profession asked itself in earnest every day?
But then I think of the work of Malcolm Gladwell, a staff writer for The New Yorker and another bestselling author, and I think maybe it's a question we're answering all the time, even when we don't realize it.
If taken to its logical conclusion, Gladwell's book Blink:The Power of Thinking Without Thinking suggests that those of us in EMS and healthcare are constantly adding to an internal data bank of experience that we draw upon every shift.
Most busy urban systems share one common trait -- a particular pride in being able to walk into a room and know without even speaking with a patient whether they're "sick or not sick."
In observing various partners over the years in these busy systems, I'm amazed at the accuracy of their split-second assessments.
Gladwell wouldn't be.
A relatively new field of study in psychology, Gladwell says it's the brain's "adaptive unconscious" that allows for these uncannily accurate predictions based on the slimmest of evidence.
Ever wondered how that medic you work with was able to take a look at a patient and know it's a head bleed or CHF or STEMI before you've even put the first-in bag on the kitchen table?
Gladwell calls it "thin-slicing," which is "the ability of our unconscious to find patterns in situations and behavior based on very narrow slices of experience."
People who work for long periods of time in high-pressure, time-sensitive professions hone their thin-slicing skills to a razor's edge.
According to Gladwell, they have to in order to succeed.
"Thin-slicing is part of what makes the unconscious so dazzling," he writes. "But it's also what we find most problematic about rapid cognition. How is it possible to gather the necessary information for a sophisticated judgment in such a short time?"
Gladwell opines that an "automated, accelerated unconscious" processing takes over, and more often than not -- and more often, at times, than people who hashed out the same decision with lots more time and lots more data -- leads us to the right conclusion.
Tuesday, September 9, 2008
Lancaster Departments to Remain Separate
It was interesting watching how leaders in Lancaster handled a proposal to merge the fire and EMS departments.
The T&G is reporting today that the merger is off, at least for now.
The T&G is reporting today that the merger is off, at least for now.
Monday, September 8, 2008
Charge of the Popup Brigade
I should have invested in tents. Or maybe RVs. Definitely Tyvek.
I'd be a multimillionaire by now.
It's THE hottest growth industry of the post-9/11 economy, "it" of course being the sea of baubles and toys on which billions of your tax dollars have been spent in the quest to save us from the legion of Biblical plagues that terrorists are certainly preparing to unleash on us any day now.
But I worry about more than smallpox or anthrax or panflu (and that last, technically, wouldn't be the terrorists' doing, but the money to combat it all comes from the same place).
Thumb through any magazine dedicated to fire, EMS, police or "homeland security" and you can't avoid one obvious truth:
To counter Al-Qaeda's next attack on American soil, hundreds of intrepid security and safety corporations plan to send not troops but a sea of canvas tents, rubber huts and microwave-emitting RVs driven by Tyvek-suited first responders.
These companies have amassed a dazzling array of tents, pop-up trailers, tagalongs, pullalongs, tents with shower heads, red tents, blue tents, yellow tents, tents color-coded to the type of chemical agent used, Winnebagos jammed with more electronic equipment than the Space Shuttle, and of course, my personal favorite and an example of corporate synergy so refined as to make the bean counters at DynCorp or Halliburton break down and cry, one company has come out with a radio-infested combo popup trailer AND tent, whose purpose is as unclear as the entire device itself but the ads pitching it are pretty nifty.
Hopefully, if the day ever comes that we need this stuff, it will all work as planned.
Until then, I'm buying me some shares of Camping World.
FOLLOW UP: Get ready for lots and lots of new tent designs, once this report gets out there. I believe in preparedness, but sometimes I wonder how many hospitals could be built, how many ED beds opened, how many Paramedics and EMTs put on the streets, how many ventilators bought, how many doses of flu vaccine given out, how many uninsured could be covered, how many public health ills eliminated, all by redirecting even a portion of the billions and billions of dollars the federal government has spent ensuring that we have more RVs than a Utah salt flat, more tyvek suits than a field of McMansions, and that every first responder who goes to a convention is wearing the appropriate golf shirt?
A lot, I'd bet....
I'd be a multimillionaire by now.
It's THE hottest growth industry of the post-9/11 economy, "it" of course being the sea of baubles and toys on which billions of your tax dollars have been spent in the quest to save us from the legion of Biblical plagues that terrorists are certainly preparing to unleash on us any day now.
But I worry about more than smallpox or anthrax or panflu (and that last, technically, wouldn't be the terrorists' doing, but the money to combat it all comes from the same place).
Thumb through any magazine dedicated to fire, EMS, police or "homeland security" and you can't avoid one obvious truth:
To counter Al-Qaeda's next attack on American soil, hundreds of intrepid security and safety corporations plan to send not troops but a sea of canvas tents, rubber huts and microwave-emitting RVs driven by Tyvek-suited first responders.
These companies have amassed a dazzling array of tents, pop-up trailers, tagalongs, pullalongs, tents with shower heads, red tents, blue tents, yellow tents, tents color-coded to the type of chemical agent used, Winnebagos jammed with more electronic equipment than the Space Shuttle, and of course, my personal favorite and an example of corporate synergy so refined as to make the bean counters at DynCorp or Halliburton break down and cry, one company has come out with a radio-infested combo popup trailer AND tent, whose purpose is as unclear as the entire device itself but the ads pitching it are pretty nifty.
Hopefully, if the day ever comes that we need this stuff, it will all work as planned.
Until then, I'm buying me some shares of Camping World.
FOLLOW UP: Get ready for lots and lots of new tent designs, once this report gets out there. I believe in preparedness, but sometimes I wonder how many hospitals could be built, how many ED beds opened, how many Paramedics and EMTs put on the streets, how many ventilators bought, how many doses of flu vaccine given out, how many uninsured could be covered, how many public health ills eliminated, all by redirecting even a portion of the billions and billions of dollars the federal government has spent ensuring that we have more RVs than a Utah salt flat, more tyvek suits than a field of McMansions, and that every first responder who goes to a convention is wearing the appropriate golf shirt?
A lot, I'd bet....
Saturday, September 6, 2008
Soccer
My twin 6-year-old boys had soccer practice this morning.
It was the first of the new season and we squeaked it in between rain showers, although we couldn't escape the oppressive humidity.
Watching them run, particularly the Redhead with the slight hitch in his step and who looks so much like his Mother, the last four years became like a decade, or maybe two, or three.
Hard to tell, really.
I involuntarily make the connection backwards to an ambulance call in a town 40 miles and five years away.
It was a September day, perfectly blue and sunny, and I was working at my part-time job at a non-transport ALS service when we got a call for a child with a pitchfork in his head in a nearby town.
We intercepted with the fire department BLS crew downtown.
The EMT in the back jumped out as we approached the ambulance's side door and didn't say a word.
In fact, I never saw him again on the call.
He knew how sick his patient was and so he went right to our truck to drive.
He also knew there wasn't much he could add to the scene we were about to encounter.
When my partner and I got into the ambulance we found a 4-year-old boy in c-spine immobilization with a non-rebreather oxygen mask strapped to his face.
He had a bandage over the top part of his head, and you could see a half-dollar sized patch of blood through the gauze.
A small three-pronged gardening pitchfork sat on the tech bench.
I'll never forget how two of the prongs were encrusted in mud, while the third gleamed as brightly as the day it was taken down from the hardware store rack.
Somehow we discovered that the boy had been playing with a friend, and for some reason the friend had plunged the pitchfork into our patient's head.
While waiting for the ambulance, the patient's mom had removed the pitchfork and the EMTs had had the foresight to bring it with them.
The boy was seizing violently, or "to beat the band," in the EMS vernacular.
We didn't waste any time in starting transport to the hospital.
En route we got a couple IVs going, administered one drug to stop the seizures and a few others to sedate and paralyze the little boy so we could put a tube into his trachea and breath for him.
A helicopter met us at the hospital and took him to the major children's hospital about 30 miles away.
I was convinced the patient was going to die.
I couldn't imagine the infection potential of the dirt and mud that had found its way deep into his brain; I could definitely imagine the trauma the pitchfork prong caused as it made its way into the most valuable real estate in the human body, into places where our true selves are secured.
While I'm convinced there is such a thing, I don't know where the soul resides, but I know that this poor little guy had just had a sharp pointed object rammed through the machine that gives motion and action to the soul's desires.
I wasn't optimistic.
But children are wonderful, confounding creatures, and they never cease to amaze me with their ability to do the unexpected.
This little boy survived first, and then thrived.
The neurosurgeons at the hospital performed miracles; the nurses on the neuro floor made sure those miracles stuck, and had a chance to cement themselves.
A year later, I was met at the ED entrance by this little boy, who now walked with a slight hitch in his step, which I barely noticed as he came forward to give me a hug.
I remembered the names of those surgeons, not because I ever thought I'd need them, but because I thought their work was amazing, worthy of the kind of fame we reserve for rock stars and actors.
I thought my admiration would remain academic, third-hand.
Then my little redhead starting getting dizzy.
Medulloblastoma is a malignant brain tumor of the posterior fossa.
That's the part of the brain, kind of near the brain stem, that controls balance, among other things.
We learned this on Nov. 8, 2004, when a CT -- in the same ED where the little boy with the pitchfork injury had thanked us for helping him out -- ordered by an ophthalmologist investigating the source of my son's swollen optic nerves revealed a large mass in the back of my son's brain.
My little redhead, 2-years-old at the time, ended up in the same children's hospital, on the neuro floor no less, and was promptly readied for surgery on Nov. 10.
I liked the date.
Nov. 1o is the Marine Corps' birthday, and as a former Marine I couldn't imagine a better day to start a fight against brain tumors.
The day before the surgery my wife and I met with the woman who would be operating.
I knew from my follow up on our little pitchfork patient that this woman had also been on the team that had saved his life.
As the ICU nurse who cared for my son put it in the hours after that Nov. 10 operation, this woman is a miracle worker.
I won't bore you with the details of the next two years of treatments.
Suffice it to say there was lots of chemo, radiation treatments, a stem cell transplant, more than a few brushes with death.
He lost his red hair and his appetite. More than a few other kids we met in the same fight lost their lives.
My little redhead is currently tumor-free, although we know there are no guarantees.
But today I watched my little boy play soccer with a slight hitch in his step, racing around a small grass field against opponents who will sit next to him in his first grade class on Monday and joke about how much fun they had on Saturday, and I couldn't help thinking that some miracles don't always end.
Sometimes they go on and on, even playing soccer with a slight hitch in their step.
It was the first of the new season and we squeaked it in between rain showers, although we couldn't escape the oppressive humidity.
Watching them run, particularly the Redhead with the slight hitch in his step and who looks so much like his Mother, the last four years became like a decade, or maybe two, or three.
Hard to tell, really.
I involuntarily make the connection backwards to an ambulance call in a town 40 miles and five years away.
It was a September day, perfectly blue and sunny, and I was working at my part-time job at a non-transport ALS service when we got a call for a child with a pitchfork in his head in a nearby town.
We intercepted with the fire department BLS crew downtown.
The EMT in the back jumped out as we approached the ambulance's side door and didn't say a word.
In fact, I never saw him again on the call.
He knew how sick his patient was and so he went right to our truck to drive.
He also knew there wasn't much he could add to the scene we were about to encounter.
When my partner and I got into the ambulance we found a 4-year-old boy in c-spine immobilization with a non-rebreather oxygen mask strapped to his face.
He had a bandage over the top part of his head, and you could see a half-dollar sized patch of blood through the gauze.
A small three-pronged gardening pitchfork sat on the tech bench.
I'll never forget how two of the prongs were encrusted in mud, while the third gleamed as brightly as the day it was taken down from the hardware store rack.
Somehow we discovered that the boy had been playing with a friend, and for some reason the friend had plunged the pitchfork into our patient's head.
While waiting for the ambulance, the patient's mom had removed the pitchfork and the EMTs had had the foresight to bring it with them.
The boy was seizing violently, or "to beat the band," in the EMS vernacular.
We didn't waste any time in starting transport to the hospital.
En route we got a couple IVs going, administered one drug to stop the seizures and a few others to sedate and paralyze the little boy so we could put a tube into his trachea and breath for him.
A helicopter met us at the hospital and took him to the major children's hospital about 30 miles away.
I was convinced the patient was going to die.
I couldn't imagine the infection potential of the dirt and mud that had found its way deep into his brain; I could definitely imagine the trauma the pitchfork prong caused as it made its way into the most valuable real estate in the human body, into places where our true selves are secured.
While I'm convinced there is such a thing, I don't know where the soul resides, but I know that this poor little guy had just had a sharp pointed object rammed through the machine that gives motion and action to the soul's desires.
I wasn't optimistic.
But children are wonderful, confounding creatures, and they never cease to amaze me with their ability to do the unexpected.
This little boy survived first, and then thrived.
The neurosurgeons at the hospital performed miracles; the nurses on the neuro floor made sure those miracles stuck, and had a chance to cement themselves.
A year later, I was met at the ED entrance by this little boy, who now walked with a slight hitch in his step, which I barely noticed as he came forward to give me a hug.
I remembered the names of those surgeons, not because I ever thought I'd need them, but because I thought their work was amazing, worthy of the kind of fame we reserve for rock stars and actors.
I thought my admiration would remain academic, third-hand.
Then my little redhead starting getting dizzy.
Medulloblastoma is a malignant brain tumor of the posterior fossa.
That's the part of the brain, kind of near the brain stem, that controls balance, among other things.
We learned this on Nov. 8, 2004, when a CT -- in the same ED where the little boy with the pitchfork injury had thanked us for helping him out -- ordered by an ophthalmologist investigating the source of my son's swollen optic nerves revealed a large mass in the back of my son's brain.
My little redhead, 2-years-old at the time, ended up in the same children's hospital, on the neuro floor no less, and was promptly readied for surgery on Nov. 10.
I liked the date.
Nov. 1o is the Marine Corps' birthday, and as a former Marine I couldn't imagine a better day to start a fight against brain tumors.
The day before the surgery my wife and I met with the woman who would be operating.
I knew from my follow up on our little pitchfork patient that this woman had also been on the team that had saved his life.
As the ICU nurse who cared for my son put it in the hours after that Nov. 10 operation, this woman is a miracle worker.
I won't bore you with the details of the next two years of treatments.
Suffice it to say there was lots of chemo, radiation treatments, a stem cell transplant, more than a few brushes with death.
He lost his red hair and his appetite. More than a few other kids we met in the same fight lost their lives.
My little redhead is currently tumor-free, although we know there are no guarantees.
But today I watched my little boy play soccer with a slight hitch in his step, racing around a small grass field against opponents who will sit next to him in his first grade class on Monday and joke about how much fun they had on Saturday, and I couldn't help thinking that some miracles don't always end.
Sometimes they go on and on, even playing soccer with a slight hitch in their step.
Wednesday, September 3, 2008
Follow-ups
Just a couple quick items to follow-up on things CMM has blogged on earlier:
It seems North Brookfield EMS has gotten its contract with the town. According to the Telegram, the deal is for a year and provides the service access to $25,000 that town voters approved earlier this year.
Ominously, though, it sounds like the deal would allow the town to put up its own ambulance with town employees (I assume they mean the Fire Department) and break the contract with just a month's notice.
In Gardner, the City Council has decided against signing-on with a company that would collect money from at-fault drivers to recoup the costs of fire and police responses to the accidents they cause.
Rather than defeating the proposal by official vote, the city council simply removed it from their calendar, achieving the same goal.
Cost Recovery Systems, of Dayton, Ohio, is a company that promises to recoup the cost of sending fire and police vehicles to accident scenes by targetting the drivers deemed at-fault in the accident and sending them a bill.
I'm sure a good chunk of the money ends up in Cost Recovery's pockets.
A couple other communities in the state have or are nearing deals with this outfit.
I applaud the Gardner City Council for steering clear of this whole mess.
Money is good, but at what cost?
To me, it's a pretty thinly veiled attempt at allowing police and fire departments to start billing for services that have traditionally generated no revenue.
I couldn't agree more with City Councilor Kim Dembrosky, who said after the move was defeated that “sometimes people say that government goes a little too far. I think this would have been one of those cases.”
Amen.
It seems North Brookfield EMS has gotten its contract with the town. According to the Telegram, the deal is for a year and provides the service access to $25,000 that town voters approved earlier this year.
Ominously, though, it sounds like the deal would allow the town to put up its own ambulance with town employees (I assume they mean the Fire Department) and break the contract with just a month's notice.
In Gardner, the City Council has decided against signing-on with a company that would collect money from at-fault drivers to recoup the costs of fire and police responses to the accidents they cause.
Rather than defeating the proposal by official vote, the city council simply removed it from their calendar, achieving the same goal.
Cost Recovery Systems, of Dayton, Ohio, is a company that promises to recoup the cost of sending fire and police vehicles to accident scenes by targetting the drivers deemed at-fault in the accident and sending them a bill.
I'm sure a good chunk of the money ends up in Cost Recovery's pockets.
A couple other communities in the state have or are nearing deals with this outfit.
I applaud the Gardner City Council for steering clear of this whole mess.
Money is good, but at what cost?
To me, it's a pretty thinly veiled attempt at allowing police and fire departments to start billing for services that have traditionally generated no revenue.
I couldn't agree more with City Councilor Kim Dembrosky, who said after the move was defeated that “sometimes people say that government goes a little too far. I think this would have been one of those cases.”
Amen.
Friday, August 29, 2008
Planting The Left Foot
I was thinking today, as I looked at the flattened toes on my patient's left foot, about the powerlessness of words at certain times.
Fortunately, there's a unique vocabulary that goes along with the art and science of caring for the sick and injured.
Heart attack patients "circle the drain."
When the drain is empty, they "code."
Congestive heart failure patients who are in acute distress are "full to the gills," while an equally troubled asthmatic or COPD patient is "tight as a drum."
The ambulance is a "bus,"a significantly hypoglycemic patient is "gorked," and a car rammed high-speed into a tree, trapping its occupants, is a "pin job."
And, of course, limbs that get run over by heavy industrial equipment are "pancaked."
Today's patient is a middle-aged guy who has worked in a factory for 30 years.
"Without an injury," he proudly notes.
Pause.
"Until today!" we say in unison.
It gets the patient laughing, enough that he cheerfully says that he thinks the injury might help his golf game by forcing him to plant that left foot more.
His toes are flattened into gelatinous stubs.
There is not even the slightest suggestion of boney formations left. It's as if the four toes have become the necks from those steamed clams everyone eats on the Cape each summer, with only the big toe miraculously escaping serious harm.
We splint the limb and give him fentanyl for analgesia, and since we're about 40 minutes by ground from the surgeons who have the only shot at saving what's left of the patient's left foot, we send him by helicopter to save time.
Throughout the whole ordeal our patient stayed calm and kept his sense of humor, no small task for someone who, in an instant, is now forced to perhaps say goodbye to an important piece of anatomy.
This is the second time in a couple of weeks that I've really been impressed with a patient.
In the urban systems in which I work, I've had patients call 911 to get a prescription refilled, or because they're convinced that an ambulance ride means faster service in the ED.
Earlier this year I had one of our frequent fliers call 911 demanding to be brought to the hospital for a pregnancy test.
But patients like today's prove that one piece of vocabulary to describe our patients needs no improvement.
It's quite enough to name it for what it was.
Courage.
Fortunately, there's a unique vocabulary that goes along with the art and science of caring for the sick and injured.
Heart attack patients "circle the drain."
When the drain is empty, they "code."
Congestive heart failure patients who are in acute distress are "full to the gills," while an equally troubled asthmatic or COPD patient is "tight as a drum."
The ambulance is a "bus,"a significantly hypoglycemic patient is "gorked," and a car rammed high-speed into a tree, trapping its occupants, is a "pin job."
And, of course, limbs that get run over by heavy industrial equipment are "pancaked."
Today's patient is a middle-aged guy who has worked in a factory for 30 years.
"Without an injury," he proudly notes.
Pause.
"Until today!" we say in unison.
It gets the patient laughing, enough that he cheerfully says that he thinks the injury might help his golf game by forcing him to plant that left foot more.
His toes are flattened into gelatinous stubs.
There is not even the slightest suggestion of boney formations left. It's as if the four toes have become the necks from those steamed clams everyone eats on the Cape each summer, with only the big toe miraculously escaping serious harm.
We splint the limb and give him fentanyl for analgesia, and since we're about 40 minutes by ground from the surgeons who have the only shot at saving what's left of the patient's left foot, we send him by helicopter to save time.
Throughout the whole ordeal our patient stayed calm and kept his sense of humor, no small task for someone who, in an instant, is now forced to perhaps say goodbye to an important piece of anatomy.
This is the second time in a couple of weeks that I've really been impressed with a patient.
In the urban systems in which I work, I've had patients call 911 to get a prescription refilled, or because they're convinced that an ambulance ride means faster service in the ED.
Earlier this year I had one of our frequent fliers call 911 demanding to be brought to the hospital for a pregnancy test.
But patients like today's prove that one piece of vocabulary to describe our patients needs no improvement.
It's quite enough to name it for what it was.
Courage.
Saturday, August 23, 2008
Podcast Education; How Much For That Speedy Dry In The Window?; Blog Loss; ECG ABCs Course
Looking for ways to keep up with some of the current research in EMS and related topics?
The Web offers plenty of opportunities and from time-to-time I'll try to spotlight ones I like.
For today's installment let me direct you to phtlspodcast.com
The site allows you to listen to talks by physicians and national leaders in trauma research via audio streaming on several dozen trauma-related topics, everything from shock and spinal cord injuries to the current state of research into fluid resuscitation.
You can also download the lectures to your mp3 player for listening later (Apple iTunes actually has a pretty remarkable selection of mp3 medical lectures available for free on its site -- but more on that another time).
The interface is easy to use, the audio is excellent quality, and you would be hard-pressed to find a better source of cutting edge information on trauma care, current practices and future developments.
I don't know how I feel about this idea making the rounds in Winchendon.
I can see the rationale for charging at-fault drivers for the cost of the emergency response to the accidents they cause, but something about it doesn't sit well with me.
I mean, why not start charging anyone who calls 911 and sends an ambulance, police car and fire engine out the door?
Should we start charging patients who call 911 then refuse to go to the hospital? How about hypoglycemics who refuse to go to the hospital once EMS corrects their low-blood sugar with an IV and amp of D50?
I don't know if I like the sound of any of that.
My feeling is that we're a public service, and the public shouldn't have to worry about how much it might cost them to call us.
This will bear some watching.
FOLLOW UP: Here's the Web site for the Dayton, Ohio-based company that is mentioned in the Telegram story. It sounds suspiciously like a way for police departments to finally bill for some of their services, and for fire departments to bill for something other than inspections and ambulance runs.
I'm sorry to say that one of my favorite blogs may be no more. The Boston EMS paramedic who wrote Other People's Emergencies announced this week that he was suspending his blog for the time being due to his activation in the armed forces, and that in all likelihood the blog is done permanently.
That would be a huge loss to his readers, but the blog remains up for now, and I highly recommend following the link above to read his archive. Let's hope this is just a temporary interruption.
This course comes highly recommended by a friend of mine whose acumen at choosing excellent courses is legendary.
"The ABCs of ECGs: Essentials for Frontline Clinicians" is being held on Nov. 1 at the InterContinental Hotel in Boston, and is a continuing medical education event sponsored by Harvard Medical School.
The course announcement claims that there will be something of interest to every level of provider here, and some of the topics covered during the day are definitely relevant to EMS, for example:
"Basic Principles: How to Read an ECG"
"Artifacts, Lead Misplacements and Normal Variants"
"Avoiding ECG Fumbles and Errors"
"Bradycardia: Causes of Pauses"
"Metabolic Abnormalities and Drug Effects/Toxicities"
The course costs $170 for everyone except docs, who get to pay $350.
The Web offers plenty of opportunities and from time-to-time I'll try to spotlight ones I like.
For today's installment let me direct you to phtlspodcast.com
The site allows you to listen to talks by physicians and national leaders in trauma research via audio streaming on several dozen trauma-related topics, everything from shock and spinal cord injuries to the current state of research into fluid resuscitation.
You can also download the lectures to your mp3 player for listening later (Apple iTunes actually has a pretty remarkable selection of mp3 medical lectures available for free on its site -- but more on that another time).
The interface is easy to use, the audio is excellent quality, and you would be hard-pressed to find a better source of cutting edge information on trauma care, current practices and future developments.
I don't know how I feel about this idea making the rounds in Winchendon.
I can see the rationale for charging at-fault drivers for the cost of the emergency response to the accidents they cause, but something about it doesn't sit well with me.
I mean, why not start charging anyone who calls 911 and sends an ambulance, police car and fire engine out the door?
Should we start charging patients who call 911 then refuse to go to the hospital? How about hypoglycemics who refuse to go to the hospital once EMS corrects their low-blood sugar with an IV and amp of D50?
I don't know if I like the sound of any of that.
My feeling is that we're a public service, and the public shouldn't have to worry about how much it might cost them to call us.
This will bear some watching.
FOLLOW UP: Here's the Web site for the Dayton, Ohio-based company that is mentioned in the Telegram story. It sounds suspiciously like a way for police departments to finally bill for some of their services, and for fire departments to bill for something other than inspections and ambulance runs.
I'm sorry to say that one of my favorite blogs may be no more. The Boston EMS paramedic who wrote Other People's Emergencies announced this week that he was suspending his blog for the time being due to his activation in the armed forces, and that in all likelihood the blog is done permanently.
That would be a huge loss to his readers, but the blog remains up for now, and I highly recommend following the link above to read his archive. Let's hope this is just a temporary interruption.
This course comes highly recommended by a friend of mine whose acumen at choosing excellent courses is legendary.
"The ABCs of ECGs: Essentials for Frontline Clinicians" is being held on Nov. 1 at the InterContinental Hotel in Boston, and is a continuing medical education event sponsored by Harvard Medical School.
The course announcement claims that there will be something of interest to every level of provider here, and some of the topics covered during the day are definitely relevant to EMS, for example:
"Basic Principles: How to Read an ECG"
"Artifacts, Lead Misplacements and Normal Variants"
"Avoiding ECG Fumbles and Errors"
"Bradycardia: Causes of Pauses"
"Metabolic Abnormalities and Drug Effects/Toxicities"
The course costs $170 for everyone except docs, who get to pay $350.
WEMS Names New Deputy Chief
UMassMemorial/Worcester EMS officially named Monday Night Group Shift Captain Michael Hunter as the service's new Deputy Chief.
DC Hunter was named to the post late last month and replaces former DC Ed Ramstrom, who has decided to go back on the road as a street medic after nearly six years as deputy.
With an EMS career that has spanned 26 years, the last 16 at WEMS, DC Hunter brings to the table a strong commitment to professionalism and patient care.
A North Brookfield native and current Holden resident, where he lives with his wife, April, a nurse practitioner, DC Hunter first became an EMT in 1982 and volunteered for the former North Brookfield Rescue Squad (now North Brookfield EMS) and the town fire department for a dozen years.
He completed paramedic training in Brattleboro, Vt., in 1983, and by 1984 was a nationally registered paramedic working at a non-transport service covering 10 towns out of Marlboro Hospital.
That service shut down in 1989 and DC Hunter went on to serve as the ALS coordinator for the original Marlboro-Hudson Ambulance and its successor after a merger with Ruggerio.
In 1992, DC Hunter was among the first group of medics hired by WEMS after it became part of UMassMemorial.
DC Hunter is a strong proponent of the Prehospital Trauma Life Support program and a member of its Executive Council, teaching at numerous conferences here and abroad, including his recent trip as part of the first PHTLS course taught in Muscat, Oman.
In an email exchange with Central Mass Medics, DC Hunter elaborated on the personal philosophy he intends to bring to his new position, and the future challenges he sees facing EMS as a whole.
CMM: What principles guide you, both as a medic and now as Deputy Chief?
MH: I always try to remember a few key phrases at work and in my personal life. One, loyalty above all else, except honor. Two, lead from the front and, finally, three, actions speak louder than words.
CMM: It might be a bit cliche to say it, but EMS seems to be at a crossroads today. It seems like the industry -- for years in the shadow of more-established brethren like the police and fire services -- is on the cusp of something, but it's hard to tell whether that something is a leap forward or backward. What do you see as some of the challenges facing our profession?
MH: At a national level -- and locally -- recognition is a huge problem. With recognition comes respect. We need to continually build positive relationships with the media, political leaders and the medical community. We need to become involved in committee work at the local, state and national levels. We are the experts in our field, and our opinions and thoughts need to be heard by the ones making global healthcare decisions. We also have a duty to educate the public and we need to advocate for public health. There are many places where our voices will lend credibility and depth to healthcare issues. Seatbelt use, car seat compliance, bicycle helmets, stroke and cardiac disease awareness, elder care and referral to services are just a few examples of worthwhile causes. Through our involvement in these issues will come recognition and respect.
We are also a young profession and our leaders are still developing. We all need to remind ourselves to look backward and help bring the new group of providers along. The newest members of our profession should not have to make the same mistakes we did. It's not a rite of passage. I think we all should also remember that involvement in medicine, especially in a young profession like EMS, is a dynamic process. We must all be "life-long learners." Too often we find ourselves basing decisions and actions solely on tradition. We must all be willing and eager to learn new technologies, theories and ways of working smarter. If we don't, we're doomed to make the same mistakes of those before us. Tradition and folklore have a place in the EMS society, but must be kept in perspective and we must not be rigid in our resistance to change.
CMM: Deputy Chief is a demanding position, especially at a service as busy as WEMS. How will you approach your new duties?
MH: I feel that four principals are paramount for my new position, and I try to adhere to them with every decision and action.
One, leadership. Leaders choose to lead. They must understand the consequences of their decisions and accept the responsibility of their failures, and successes. Leaders also lead from the front.
Two, respect. We should treat everyone as we would expect them to treat us. This holds true at many levels -- patients, peers, supervisors, subordinates and the general public. Putting on a uniform implies a position of authority, and with that comes the responsibility to act accordingly.
Three, communication. It is much easier to lead if everyone knows the direction we're going. The goals and expectations of a project or action need to be understood by everyone involved. Communication involves at least two parties, and the best ideas don't always come from the top down. It is important to remember that you cannot listen if you're constantly speaking.
Four, evaluate. We should always step back and evaluate every decision we make or action we take. This goes to life-long learning. Is there a better or smarter way or doing what I just did? Was my action in the best interest of my patient, partner and service? It goes to what Einstein said about insanity -- that doing the same thing twice but expecting a different result is a sign of insanity. Older medical professionals embrace mortality and morbidity rounds as learning experiences. EMS tends to embrace defending our own actions, even when they are proven to be less than correct -- or even deleterious -- to ourselves, patients and reputations as healthcare providers.
The medics, physicians and communication specialists of WEMS are a great and diverse group of individuals. They each bring unique strengths, backgrounds and experiences to the table. One of the strongest bonds the members of WEMS share is the desire to be the best and provide the highest possible level of care and service to the population we serve.
It is an honor to have been chosen as Deputy Chief and I'm looking forward to learning and growing into this position. WEMS is a great place. I'm very happy to be here and will do the best I can to keep it a great place.
DC Hunter was named to the post late last month and replaces former DC Ed Ramstrom, who has decided to go back on the road as a street medic after nearly six years as deputy.
With an EMS career that has spanned 26 years, the last 16 at WEMS, DC Hunter brings to the table a strong commitment to professionalism and patient care.
A North Brookfield native and current Holden resident, where he lives with his wife, April, a nurse practitioner, DC Hunter first became an EMT in 1982 and volunteered for the former North Brookfield Rescue Squad (now North Brookfield EMS) and the town fire department for a dozen years.
He completed paramedic training in Brattleboro, Vt., in 1983, and by 1984 was a nationally registered paramedic working at a non-transport service covering 10 towns out of Marlboro Hospital.
That service shut down in 1989 and DC Hunter went on to serve as the ALS coordinator for the original Marlboro-Hudson Ambulance and its successor after a merger with Ruggerio.
In 1992, DC Hunter was among the first group of medics hired by WEMS after it became part of UMassMemorial.
DC Hunter is a strong proponent of the Prehospital Trauma Life Support program and a member of its Executive Council, teaching at numerous conferences here and abroad, including his recent trip as part of the first PHTLS course taught in Muscat, Oman.
In an email exchange with Central Mass Medics, DC Hunter elaborated on the personal philosophy he intends to bring to his new position, and the future challenges he sees facing EMS as a whole.
CMM: What principles guide you, both as a medic and now as Deputy Chief?
MH: I always try to remember a few key phrases at work and in my personal life. One, loyalty above all else, except honor. Two, lead from the front and, finally, three, actions speak louder than words.
CMM: It might be a bit cliche to say it, but EMS seems to be at a crossroads today. It seems like the industry -- for years in the shadow of more-established brethren like the police and fire services -- is on the cusp of something, but it's hard to tell whether that something is a leap forward or backward. What do you see as some of the challenges facing our profession?
MH: At a national level -- and locally -- recognition is a huge problem. With recognition comes respect. We need to continually build positive relationships with the media, political leaders and the medical community. We need to become involved in committee work at the local, state and national levels. We are the experts in our field, and our opinions and thoughts need to be heard by the ones making global healthcare decisions. We also have a duty to educate the public and we need to advocate for public health. There are many places where our voices will lend credibility and depth to healthcare issues. Seatbelt use, car seat compliance, bicycle helmets, stroke and cardiac disease awareness, elder care and referral to services are just a few examples of worthwhile causes. Through our involvement in these issues will come recognition and respect.
We are also a young profession and our leaders are still developing. We all need to remind ourselves to look backward and help bring the new group of providers along. The newest members of our profession should not have to make the same mistakes we did. It's not a rite of passage. I think we all should also remember that involvement in medicine, especially in a young profession like EMS, is a dynamic process. We must all be "life-long learners." Too often we find ourselves basing decisions and actions solely on tradition. We must all be willing and eager to learn new technologies, theories and ways of working smarter. If we don't, we're doomed to make the same mistakes of those before us. Tradition and folklore have a place in the EMS society, but must be kept in perspective and we must not be rigid in our resistance to change.
CMM: Deputy Chief is a demanding position, especially at a service as busy as WEMS. How will you approach your new duties?
MH: I feel that four principals are paramount for my new position, and I try to adhere to them with every decision and action.
One, leadership. Leaders choose to lead. They must understand the consequences of their decisions and accept the responsibility of their failures, and successes. Leaders also lead from the front.
Two, respect. We should treat everyone as we would expect them to treat us. This holds true at many levels -- patients, peers, supervisors, subordinates and the general public. Putting on a uniform implies a position of authority, and with that comes the responsibility to act accordingly.
Three, communication. It is much easier to lead if everyone knows the direction we're going. The goals and expectations of a project or action need to be understood by everyone involved. Communication involves at least two parties, and the best ideas don't always come from the top down. It is important to remember that you cannot listen if you're constantly speaking.
Four, evaluate. We should always step back and evaluate every decision we make or action we take. This goes to life-long learning. Is there a better or smarter way or doing what I just did? Was my action in the best interest of my patient, partner and service? It goes to what Einstein said about insanity -- that doing the same thing twice but expecting a different result is a sign of insanity. Older medical professionals embrace mortality and morbidity rounds as learning experiences. EMS tends to embrace defending our own actions, even when they are proven to be less than correct -- or even deleterious -- to ourselves, patients and reputations as healthcare providers.
The medics, physicians and communication specialists of WEMS are a great and diverse group of individuals. They each bring unique strengths, backgrounds and experiences to the table. One of the strongest bonds the members of WEMS share is the desire to be the best and provide the highest possible level of care and service to the population we serve.
It is an honor to have been chosen as Deputy Chief and I'm looking forward to learning and growing into this position. WEMS is a great place. I'm very happy to be here and will do the best I can to keep it a great place.
Friday, August 22, 2008
Courage Under Fire
The patient was a teenager, but he looked like he was 12-years-old.
In the 45-minutes I was with or near him, he passed out four or five times.
His normally-beating heart was betraying him, his atria quivering when they should have been contracting in synchrony.
It's not the sort of thing a young man's heart typically does.
We started two IVs on him; the ED added a third.
His heart rate never dropped below 130 beats per minute, and twice -- once when we moved him over to the ED bed and another time for no good reason -- accelerated to 280 plus.
Eventually, the ED threw the drug box at him -- Amio, Mag, Versed.
Before the cardioversions began they even gave him some Etomidate.
Anesthesia came down with their bag of tricks as the docs considered intubating him, but this kid was tough.
He maintained his own airway and defied our system's plans to take away his ability to breath unaided by machines or people, probably the most basic proof we have that we're alive.
The docs shocked him 5 times. A helicopter was called, and by the time they took him to the city he was doing much better.
As they wheeled him out the door I tapped him on the shoulder and told him to hang in there.
He nodded, but it seemed like he was already dealing with his condition better than any of us.
Today was a bad day, but not the worst for this young man in his brief life.
Diagnosed with a form of bone marrow failure and chronic anemia when he was just a few months old, the patient's disease has left him with an alcoholic's liver and a 90-year-old's heart, and he bears a 12-inch half-moon scar down his abdomen from where they'd removed his spleen at one point.
And despite all this, despite having a million and one reasons to complain, to feel sorry for himself, to do any one of the legion of things I might do if faced with a similar path, our patient was calm, almost stoic.
He answered questions and described his condition with the maturity of someone three times his age.
I don't know that I've been more impressed with a patient.
We hear a lot about courage and heroism.
Most of it is crap.
This kid was the real deal. He knew how sick he was, better than us -- better than ANY of us there that day, and he was the calmest one in the room.
The patient has what's known as Diamond-Blackfan anemia.
If you haven't heard of it, don't sweat it.
There are only 500 cases in America.
The condition is a member of the family of inherited bone marrow failure syndromes (IBMFS), and according to imedicine.com it's incidence in the U.S. is somewhere between 2 and 6 cases per million people.
It usually appears first in early infancy and is marked by a pure red blood cell aplasia, which means that the patient's bone marrow lacks any red blood cell precursors.
About a quarter of those cases result from gene mutation; the other 75 percent, apparently, appear mysteriously.
The treatment generally includes lots and lots of transfusions, which can lead to cardiac arrythmias, congestive heart failure, iron overload, stunted growth and infections.
For my partner and I, the acute dilemma was twofold.
The patient presented with a rapid AF in the 150s, but also threw pretty frequent runs of Vtach.
It was a unique ECG strip, to say the least.
His pressure was Ok, 124/70 bilaterally, but he was able to tell us that he has had episodes of acute hypotension with Dilt.
So we worried about dropping his pressure.
The Vtach was problematic, too, because we worried about giving Amio due to the hepatic issues, what with Amio being excreted mainly by the liver.
We ended up contacting med control.
The online doc, having already spoken to the city specialist who treats this young man, told us to give a little fluid but, as long as he continued with a stable hemo status, otherwise just observe.
Given how complex his treatment course in the ED became, I'm glad this is the course we took.
Sometimes less is definitely more.
Even as I write this, I wonder how this patient is doing.
Unless we return to his house, I doubt I'll find out.
And if we have to return to his house, it can only mean that things aren't going well.
In the 45-minutes I was with or near him, he passed out four or five times.
His normally-beating heart was betraying him, his atria quivering when they should have been contracting in synchrony.
It's not the sort of thing a young man's heart typically does.
We started two IVs on him; the ED added a third.
His heart rate never dropped below 130 beats per minute, and twice -- once when we moved him over to the ED bed and another time for no good reason -- accelerated to 280 plus.
Eventually, the ED threw the drug box at him -- Amio, Mag, Versed.
Before the cardioversions began they even gave him some Etomidate.
Anesthesia came down with their bag of tricks as the docs considered intubating him, but this kid was tough.
He maintained his own airway and defied our system's plans to take away his ability to breath unaided by machines or people, probably the most basic proof we have that we're alive.
The docs shocked him 5 times. A helicopter was called, and by the time they took him to the city he was doing much better.
As they wheeled him out the door I tapped him on the shoulder and told him to hang in there.
He nodded, but it seemed like he was already dealing with his condition better than any of us.
Today was a bad day, but not the worst for this young man in his brief life.
Diagnosed with a form of bone marrow failure and chronic anemia when he was just a few months old, the patient's disease has left him with an alcoholic's liver and a 90-year-old's heart, and he bears a 12-inch half-moon scar down his abdomen from where they'd removed his spleen at one point.
And despite all this, despite having a million and one reasons to complain, to feel sorry for himself, to do any one of the legion of things I might do if faced with a similar path, our patient was calm, almost stoic.
He answered questions and described his condition with the maturity of someone three times his age.
I don't know that I've been more impressed with a patient.
We hear a lot about courage and heroism.
Most of it is crap.
This kid was the real deal. He knew how sick he was, better than us -- better than ANY of us there that day, and he was the calmest one in the room.
The patient has what's known as Diamond-Blackfan anemia.
If you haven't heard of it, don't sweat it.
There are only 500 cases in America.
The condition is a member of the family of inherited bone marrow failure syndromes (IBMFS), and according to imedicine.com it's incidence in the U.S. is somewhere between 2 and 6 cases per million people.
It usually appears first in early infancy and is marked by a pure red blood cell aplasia, which means that the patient's bone marrow lacks any red blood cell precursors.
About a quarter of those cases result from gene mutation; the other 75 percent, apparently, appear mysteriously.
The treatment generally includes lots and lots of transfusions, which can lead to cardiac arrythmias, congestive heart failure, iron overload, stunted growth and infections.
For my partner and I, the acute dilemma was twofold.
The patient presented with a rapid AF in the 150s, but also threw pretty frequent runs of Vtach.
It was a unique ECG strip, to say the least.
His pressure was Ok, 124/70 bilaterally, but he was able to tell us that he has had episodes of acute hypotension with Dilt.
So we worried about dropping his pressure.
The Vtach was problematic, too, because we worried about giving Amio due to the hepatic issues, what with Amio being excreted mainly by the liver.
We ended up contacting med control.
The online doc, having already spoken to the city specialist who treats this young man, told us to give a little fluid but, as long as he continued with a stable hemo status, otherwise just observe.
Given how complex his treatment course in the ED became, I'm glad this is the course we took.
Sometimes less is definitely more.
Even as I write this, I wonder how this patient is doing.
Unless we return to his house, I doubt I'll find out.
And if we have to return to his house, it can only mean that things aren't going well.
Wednesday, August 20, 2008
North Brookfield On The Ropes?
From the Things Are Tough Everywhere file, this story about the financial woes of North Brookfield EMS.
I hate to see these third-service non-profits have such tough times. My first job as a Paramedic was with New Britain EMS in New Britain, Conn., a third-service non-profit with loose ties to the former New Britain General Hospital (it now has some new convoluted name that I can't even begin to remember).
I loved every minute I worked there.
There are numerous examples of such services thriving here in Massachusetts -- Spencer Rescue and Webster EMS come immediately to mind -- but obviously the financials can seem insurmountable.
On an editorial note, and although all I know of the proposed contract with the town is from what I read in the paper, I'd have to agree that it would be cost-prohibitive for a town with a call volume as low as North Brookfield's to insist on TWO 24/7 dual medic trucks dedicated solely to 911 calls.
Frankly, I don't know how they'd pay for it.
I wish North Brookfield EMS all the best.
I hate to see these third-service non-profits have such tough times. My first job as a Paramedic was with New Britain EMS in New Britain, Conn., a third-service non-profit with loose ties to the former New Britain General Hospital (it now has some new convoluted name that I can't even begin to remember).
I loved every minute I worked there.
There are numerous examples of such services thriving here in Massachusetts -- Spencer Rescue and Webster EMS come immediately to mind -- but obviously the financials can seem insurmountable.
On an editorial note, and although all I know of the proposed contract with the town is from what I read in the paper, I'd have to agree that it would be cost-prohibitive for a town with a call volume as low as North Brookfield's to insist on TWO 24/7 dual medic trucks dedicated solely to 911 calls.
Frankly, I don't know how they'd pay for it.
I wish North Brookfield EMS all the best.
Monday, August 18, 2008
Some Blogs I Like
I like blogs.
Actually, I LOVE them. It's like they exist in real-time, and speak directly to their readers, unlike what most Web sites have become these days -- marketing tools meant to tease you into buying something; hopelessly out-of-date, at least by 2008 standards. I mean, who wants to linger at a Web site that was last updated 8 months ago?
So here are a few of my favorites. One of the best things about each of these blogs are that they link to dozens of others, each of which links to dozens of others, and so on, until suddenly you realize there are tens of thousands of people writing blogs just about ambulances and EMS, which is pretty cool.
Wormtown Medic. Written by a co-worker, it's a new blog that focuses on Worcester EMS in Worcester, Mass. Anyone who knows its author, Rod Witkos, knows it will be opinionated, insightful, definitely funny and a must-read worthy of a Bookmark. For those of you wondering about the title, "Wormtown" is a city nickname that has stuck around for a few decades despite some opposition among more sensitive residents. I always liked the name.
Rescuing Providence is a blog written by Lt. Michael Morse of the Providence Fire Department.
This is a great blog written by a guy who chooses to work on one of the busiest ambulances in America despite having the option not to. Inspiring to those of us who don't feel the need to apologize for being passionate about EMS. Another must-read.
Other People's Emergencies focuses on Boston and is written by a veteran Boston EMS medic.
This blog captures the experience of urban EMS in all its facets like few others I've come across. No war stories, just clear-eyed observation underscored by keen analysis of the day-t0-day life of an urban Paramedic.
Random Acts of Reality is a blog written by an EMT for the London Ambulance Service. Well-written and funny, it also goes to show that a 3,000 mile gap doesn't mean much when it comes to EMS. The things that make the job great and galling are universal, it seems.
Brick City Blues covers the daily (and nightly) grind of working for University EMS in Newark, New Jersey. This is definitely an intense place to work, on all fronts, and the medic who writes it pulls no punches. Although in the news recently for all the wrong reasons, this is one of the nation's best EMS services and the blog is a joy to read.
Actually, I LOVE them. It's like they exist in real-time, and speak directly to their readers, unlike what most Web sites have become these days -- marketing tools meant to tease you into buying something; hopelessly out-of-date, at least by 2008 standards. I mean, who wants to linger at a Web site that was last updated 8 months ago?
So here are a few of my favorites. One of the best things about each of these blogs are that they link to dozens of others, each of which links to dozens of others, and so on, until suddenly you realize there are tens of thousands of people writing blogs just about ambulances and EMS, which is pretty cool.
Wormtown Medic. Written by a co-worker, it's a new blog that focuses on Worcester EMS in Worcester, Mass. Anyone who knows its author, Rod Witkos, knows it will be opinionated, insightful, definitely funny and a must-read worthy of a Bookmark. For those of you wondering about the title, "Wormtown" is a city nickname that has stuck around for a few decades despite some opposition among more sensitive residents. I always liked the name.
Rescuing Providence is a blog written by Lt. Michael Morse of the Providence Fire Department.
This is a great blog written by a guy who chooses to work on one of the busiest ambulances in America despite having the option not to. Inspiring to those of us who don't feel the need to apologize for being passionate about EMS. Another must-read.
Other People's Emergencies focuses on Boston and is written by a veteran Boston EMS medic.
This blog captures the experience of urban EMS in all its facets like few others I've come across. No war stories, just clear-eyed observation underscored by keen analysis of the day-t0-day life of an urban Paramedic.
Random Acts of Reality is a blog written by an EMT for the London Ambulance Service. Well-written and funny, it also goes to show that a 3,000 mile gap doesn't mean much when it comes to EMS. The things that make the job great and galling are universal, it seems.
Brick City Blues covers the daily (and nightly) grind of working for University EMS in Newark, New Jersey. This is definitely an intense place to work, on all fronts, and the medic who writes it pulls no punches. Although in the news recently for all the wrong reasons, this is one of the nation's best EMS services and the blog is a joy to read.
Not Just For Firefighters; Down With The Stairchair
Thanks to Rod from Worcester EMS for pointing out this link.
While sponsored by a group attempting to tackle health problems amongst firefighters, I think they could easily have been describing anyone who makes a living responding to emergencies with lights and sirens.
We work so hard to help those around us that it's so easy to forget about ourselves.
Although there have been some EMS initiatives, the fire service is really striving to address those things that make heart disease the most prolific killer of public safety personnel.
In perhaps a more EMS-centric vein, JEMS.com recently posted an article about back injury prevention.
This is where I find the state's declaration that we stair-chair EVERY patient to be not just ridiculous, but downright career-threatening.
Can someone please tell me why I should risk a career-ending back injury stair-chairing a Section 12 patient with no physical issues whatsoever?
With all the talk about selective c-spine immobilization and the recent research questioning the wisdom of backboarding everyone who calls 911, I think we need to look at stairchairs the same way we look at surgical airway kits -- something only to be used when needed and appropriate.
I want to do this job until I retire, and I need all my discs and vertebrae in their proper location and functional.
Here's an interesting .pdf file about expanded scope Paramedics, an idea that was in vogue for a brief period a couple of years ago. I'm always intrigued by ideas like these, but we work in Massachusetts. I'm not holding my breath...
While sponsored by a group attempting to tackle health problems amongst firefighters, I think they could easily have been describing anyone who makes a living responding to emergencies with lights and sirens.
We work so hard to help those around us that it's so easy to forget about ourselves.
Although there have been some EMS initiatives, the fire service is really striving to address those things that make heart disease the most prolific killer of public safety personnel.
In perhaps a more EMS-centric vein, JEMS.com recently posted an article about back injury prevention.
This is where I find the state's declaration that we stair-chair EVERY patient to be not just ridiculous, but downright career-threatening.
Can someone please tell me why I should risk a career-ending back injury stair-chairing a Section 12 patient with no physical issues whatsoever?
With all the talk about selective c-spine immobilization and the recent research questioning the wisdom of backboarding everyone who calls 911, I think we need to look at stairchairs the same way we look at surgical airway kits -- something only to be used when needed and appropriate.
I want to do this job until I retire, and I need all my discs and vertebrae in their proper location and functional.
Here's an interesting .pdf file about expanded scope Paramedics, an idea that was in vogue for a brief period a couple of years ago. I'm always intrigued by ideas like these, but we work in Massachusetts. I'm not holding my breath...
Sunday, August 17, 2008
Flophouses, Foyers and Lobster Trap Hearts; Plus, Does Your Doc Throw Stuff?
I worked a shift today at one of my part-time jobs, a non-transporting gig based in one of Massachusetts's most economically depressed cities.
This job is usually a good jolt to the system because in addition to this city, the service provides ALS to a couple of the state's nicest -- that is, wealthiest -- towns.
The juxtaposition can be jarring.
One call you're intubating a cardiac arrest in the fetid bathroom of a flop house and trying not to think about what the gooey stuff is that you're lying in, and the next you're evaluating the chest pain of an elderly matriarch -- whose relatives skippered the Mayflower -- in the foyer of a brick mansion that itself is bigger than your own home.
I make no judgments here about either of these patients. They both get the best I have to offer.
That's the great thing about being a Paramedic.
We don't have to worry about who these people are -- the sick and injured who call 911 or have it dialed for them.
No matter whether you're the alcoholic homeless guy at the local wet shelter who had his nose broken in a fight with another alcoholic homeless guy from the local wet shelter, or the CFO of a Fortune 500 company in flash pulmonary edema, all we have to do is treat you.
Throw in a little humanity and you're on to something...
Doctors take the hit in this article, but none of us in the field are blameless.
For me, the dangerous hour is 3 a.m.
Certain decisions that seem completely justified or rational in the middle of the night -- like throwing discarded pizza and Chinese food containers against an EMS charting room wall instead of actually asking the ED nursing staff to stop using the only table in the room as a trash bin -- will almost always be revealed during the daylight to be really, really stupid.
I've noticed that some people in healthcare seem to equate personal competency with a license to treat the rest of the field like fools or little children.
I don't know where this comes from.
Mostly I think it's a form of amnesia.
When you forget where you came from it becomes even easier to forget where you are -- a small part of a big team trying to alleviate suffering and cure illness.
For those of you who might have missed it, there's a bit of a Rennaissance happening at Spencer Rescue over the last year or so. This article in the Telegram makes reference to Spencer Rescue's pact with Paxton, and is a great example of how a little cooperation and innovative thinking can bring good things to all sides.
I don't know much about how EMS operates in Upton, but it seems changes are afoot. Although maybe unrelated to anything going on in nearby Upton, EMS in the Milford area has undergone a sea change lately, what with the sad demise of the 2181 non-transport service out of Milford Regional Medical Center. I'm not sure who's stepped in to make up for the loss of ALS coverage, other than AMR now owning the entire operation in Milford itself. Uxbridge Fire Department has been making strides to get its ALS program running, while Events and Alert Ambulance are still in the area. I'd love to hear from people who can explain where everything stands down there.
Does it seem like we respond A LOT in the course of a week for patients complaining of possible reactions to antibiotics?
It seems we're not imagining things.
A recent study found that nearly 20 percent of all hospital evaluations for adverse drug reactions involved antibiotics, affecting nearly 150,000 people.
Here's something for the Medical Oddity of the Month Club, courtesy of George, a partner of mine at the part-time job I wrote about earlier who works full-time as an RN in a cath lab.
George is one of my favorite partners of all-time, mostly because despite having over two decades on the streets as a Paramedic, George still approaches the job with a sense of wonder and a desire to learn.
I hope I have half his intellectual curiosity when I've been a medic that long.
So anyway, George had to give a little mini-lecture at a meeting of the cath lab staff on the subject of takotsubo.
Also known as Transient Left Ventricular Apical Ballooning, it's basically a deformation of the left ventricle resulting from extreme psychological or physical stress.
The name is derived from the shape of traditional Japanese lobster traps, which the stricken heart resembles.
It's kind of rare, but not unheard of. George has himself seen two of these cases in the cath lab, where he's been for less than a year.
I don't know how knowledge of this will help you directly in the field, since it's not something we'd be able to discover and even if we could, there's nothing to be done about it prehospitally.
But I'm not adverse to knowing stuff just for the sake of knowing it, and takotsubo is pretty interesting, so if you feel the same way, then bon appetit.
For those of you willing to send it along, one of my main goals for this blog is to be a resource for EMS and related news for central Massachusetts.
I'm not looking for gossip and I have no agenda other than spreading the word about goings-on in our part of the prehospital world.
If you have anything of a newsworthy nature -- and my list of things that might be considered newsworthy is pretty broad, everything from new vehicle purchases, contracts, hirings, open positions and whatnot to attaboys and award announcements -- please feel free to email it to me and I'll be sure to get it in the blog.
Also be sure to spread the word about Central Mass Medics.
This job is usually a good jolt to the system because in addition to this city, the service provides ALS to a couple of the state's nicest -- that is, wealthiest -- towns.
The juxtaposition can be jarring.
One call you're intubating a cardiac arrest in the fetid bathroom of a flop house and trying not to think about what the gooey stuff is that you're lying in, and the next you're evaluating the chest pain of an elderly matriarch -- whose relatives skippered the Mayflower -- in the foyer of a brick mansion that itself is bigger than your own home.
I make no judgments here about either of these patients. They both get the best I have to offer.
That's the great thing about being a Paramedic.
We don't have to worry about who these people are -- the sick and injured who call 911 or have it dialed for them.
No matter whether you're the alcoholic homeless guy at the local wet shelter who had his nose broken in a fight with another alcoholic homeless guy from the local wet shelter, or the CFO of a Fortune 500 company in flash pulmonary edema, all we have to do is treat you.
Throw in a little humanity and you're on to something...
Doctors take the hit in this article, but none of us in the field are blameless.
For me, the dangerous hour is 3 a.m.
Certain decisions that seem completely justified or rational in the middle of the night -- like throwing discarded pizza and Chinese food containers against an EMS charting room wall instead of actually asking the ED nursing staff to stop using the only table in the room as a trash bin -- will almost always be revealed during the daylight to be really, really stupid.
I've noticed that some people in healthcare seem to equate personal competency with a license to treat the rest of the field like fools or little children.
I don't know where this comes from.
Mostly I think it's a form of amnesia.
When you forget where you came from it becomes even easier to forget where you are -- a small part of a big team trying to alleviate suffering and cure illness.
For those of you who might have missed it, there's a bit of a Rennaissance happening at Spencer Rescue over the last year or so. This article in the Telegram makes reference to Spencer Rescue's pact with Paxton, and is a great example of how a little cooperation and innovative thinking can bring good things to all sides.
I don't know much about how EMS operates in Upton, but it seems changes are afoot. Although maybe unrelated to anything going on in nearby Upton, EMS in the Milford area has undergone a sea change lately, what with the sad demise of the 2181 non-transport service out of Milford Regional Medical Center. I'm not sure who's stepped in to make up for the loss of ALS coverage, other than AMR now owning the entire operation in Milford itself. Uxbridge Fire Department has been making strides to get its ALS program running, while Events and Alert Ambulance are still in the area. I'd love to hear from people who can explain where everything stands down there.
Does it seem like we respond A LOT in the course of a week for patients complaining of possible reactions to antibiotics?
It seems we're not imagining things.
A recent study found that nearly 20 percent of all hospital evaluations for adverse drug reactions involved antibiotics, affecting nearly 150,000 people.
Here's something for the Medical Oddity of the Month Club, courtesy of George, a partner of mine at the part-time job I wrote about earlier who works full-time as an RN in a cath lab.
George is one of my favorite partners of all-time, mostly because despite having over two decades on the streets as a Paramedic, George still approaches the job with a sense of wonder and a desire to learn.
I hope I have half his intellectual curiosity when I've been a medic that long.
So anyway, George had to give a little mini-lecture at a meeting of the cath lab staff on the subject of takotsubo.
Also known as Transient Left Ventricular Apical Ballooning, it's basically a deformation of the left ventricle resulting from extreme psychological or physical stress.
The name is derived from the shape of traditional Japanese lobster traps, which the stricken heart resembles.
It's kind of rare, but not unheard of. George has himself seen two of these cases in the cath lab, where he's been for less than a year.
I don't know how knowledge of this will help you directly in the field, since it's not something we'd be able to discover and even if we could, there's nothing to be done about it prehospitally.
But I'm not adverse to knowing stuff just for the sake of knowing it, and takotsubo is pretty interesting, so if you feel the same way, then bon appetit.
For those of you willing to send it along, one of my main goals for this blog is to be a resource for EMS and related news for central Massachusetts.
I'm not looking for gossip and I have no agenda other than spreading the word about goings-on in our part of the prehospital world.
If you have anything of a newsworthy nature -- and my list of things that might be considered newsworthy is pretty broad, everything from new vehicle purchases, contracts, hirings, open positions and whatnot to attaboys and award announcements -- please feel free to email it to me and I'll be sure to get it in the blog.
Also be sure to spread the word about Central Mass Medics.
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