The August EMS Roundup

It’s midnight in San Fransisco and I am waiting here for Jesus on my knees.

In August and everything after, I want someone else to bleed for me.

- Counting Crows, August and Everything After

A busy month indeed at The EMT Spot. This month I experimented with quality over quantity and I hope you found enough good stuff to stimulate your noggin. We started with another installment of the ultimate guide to EMT vital signs. This month we looked at respiration. Then I took another run at the controversial phrase, “Patient’s define their emergencies.” After that we talked about doctors watching EMS care on cameras and we wrapped it all up with the question, “Is there such a thing as too much information?“

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Too Much Information

It’s the week before the final exam and my EMT class is feeling the pressure. The two-hundred question final looms large on the horizon and, in less than a week, the students will need to perform five randomly selected skills stations perfectly. This is the task that has most of the students really feeling the heat.

So we do what we do every class. We practice and practice and practice. So there we were, gathered around in groups, practicing our National Registry skills sheets. That’s when Joey asked me the question that absolutely floored me. It floored me and annoyed me, but really didn’t surprise me. I’ve heard the question asked before in many different ways.

Joey finished up his medical scenario and I was giving him some feedback on his performance. He looked down at the fictional patient’s medication list that I had provided him and he shrugged his shoulders. “We don’t really have to know what all these mean right?”

I told him I didn’t understand. He mulled the thought over in his head and took another stab at it. “I mean…we need to write these down and report them to the doctor, but it isn’t important for us to know what they all do. (Pause.) As EMT’s. (Pause.) Right?”

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Doctors Watching EMS Care on Cameras?

I’m all for trying new things. I love to see the new gadgets and ideas that find their way into the prehospital arena. One of my favorite past-times is telling stories about people trying new, cool things. Having said that, some things just set off my skeptic meter. (Some people use a less PC term for “skeptic meter.)

For some reason this next story set my skeptic meter needle into the red. I’d like to know what you think.

Florida tax-payers are funding a $100,000 camera system for various key-west EMS providers that will allow doctors and trauma surgeons to view the prehospital environment remotely from the hospital. Apparently these cameras will be worn by various EMS personnel and be installed in the local transport vehicles to give the hospital a real time view of accident scenes and patient care.

The big selling point being pushed is that, when doctors are allowed to look at the patients on scene, they’ll be better prepared to receive them at the hospital. This visual benefit is supposed to be great enough to justify the tremendous financial, logistical and technological burden of installing, carrying and maintaining all these cameras. I’m not so sure.

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Patients Define Their Emergencies (Part 2)

True Story…

The dispatch information was updated before we had even rolled our rig out onto the pad. Eye injury, no serious symptoms. Jodie shut down the lights and I informed dispatch that we’d be responding non-emergent.

Up stairs and inside the small two bedroom apartment, Samantha, our patient, was waiting on the couch, holding a hot compress to her swollen right eyelid. Mom worked calmly in the kitchen finishing diner for her other two children. Alan, Samantha’s father sat on the edge of his seat next to his daughter in a state of barely containable anxiety.

He had recently arrived home from work and his wife had informed him of the apparent infection in Samantha’s right eye. One look and he was on the phone to us. Now he breathed rapidly as he fumbled through a list of questions. What caused it? Could it damage her vision? Could she lose her eye? Could she go blind?

I cleared the engine to go back in service and sat down next to him. Over the next ten minutes we both explained what pink-eye was and how to take care of it. We talked about hot-compresses and how contagious the bacteria was going to be. We reviewed the typical course for such and infection. How to prevent it in the other kids. How likely it was that one of them already had it. And we discussed his plan for morning. (It involved asking a neighbor to drive them to a near-by clinic.)

Alan called 911 for pink-eye. And…(This part is bound to be controversial, depending on what kind of system you work in.) I never offered to take him to the emergency room. And he never asked.

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The Ultimate Guide to EMT Vital Signs

Part 4: Respiration

The respiratory vital sign rounds out our “big three” vital signs. (Pulse and blood pressure being the other two.) It is, quite possibly, the most misunderstood and overlooked of the big three vitals.

Two big problems we encounter when factoring in the respiratory component of the vital signs are:

1) We’re comfortable fibbing about the true respiratory rate. More so than pulse or blood pressure, respirations encourage us to violate the first rule of vital signs. Especially when the patient is in no apparent distress. We look at the patient, we make up their respiratory rate and, quite often, we’re wrong.

2) We fail to recognize the relationship between rate and volume. In EMT school we are rarely asked about the respiratory volume. We perform our scenarios. We count a rate of respiration. We report it. The scenario moves on. In the process we forget that respiratory rate is only half of the breathing equation. Without volume, the rate means very little to us.

With those two common errors in mind, let’s talk about obtaining an accurate respiratory rate and then let’s talk about truly assessing the quality of the patients respirations. Consider this your quick guide to respiration assessment mastery.

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The July EMS Roundup

“That beautiful season the summer!

Filled was the air with a dreamy and magical light;

and the landscape

Lay as if new created in all the freshness of childhood.”

- Henry Wadsworth Longfellow

Here in Colorado, July came with all the freshness of weddings, heat and afternoon thunderstorms. I took a short break to go to California and play best man at the wedding of a great friend. And then it was back in the EMS blogging saddle. We started with a discussion about eight tragic EMS behavior flaws to avoid and then I gave you 207 reasons to stay current on you continuing education. I explained why litter begets litter and then asked you to finish the sentence, “Behind every great EMT…” We ended off with a lively discussion about fire based EMS vs. private EMS which is still raging on. Bring the storm!

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Fire Based EMS vs. Private EMS

“In Germany they first came for the communists, and I didn’t speak up because I wasn’t a communist. Then they came for the Jews, and I didn’t speak up because I wasn’t a Jew. Then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist. Then they came for the Catholics, and I didn’t speak up because I was a Protestant. Then they came for me – and by that time no one was left to speak up.”

- Rev. Martin Niemoller

Yesterday an Action Care ambulance covered my station while I was at a training. Action Care is the local private ambulance service. I know, the name always seemed a little silly to me. If a super hero ever created an ambulance service, he would most certainly call it Action Care. I joke about the name, but they’re the real deal. If you’re going to work as a private service EMT, you could do worse than Action Care. And if that doesn’t work out, there’s always the medical billing and coding field.

I’m glad we have Action Care. They help cover our district when we are low on resources. They are always professional and polite on scene. They give good care.

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Behind Every Great EMT…

Call it a curiosity. I wanted to know how the EMT Spot readers would finish the sentence, “Behind every great EMT…” So I asked.

I asked on twitter. I asked on Facebook. I even asked right here at the blog. And the answers poured in. Your responses represented the full spectrum of personalities that inhabit our workplace. There were poignant responses, cynical responses and a bunch of funny ones. The responses made me smile and frown and think.

Within this list of answers you’ll find feedback from 30+ year EMS veterans and newbies just getting their EMS feet wet. Everyone is represented. And the responses are telling.

I’m rather proud of how this little experiment turned out. I hope you find these responses as enjoyable and thought provoking as I did. Thanks for all your contributions. Aside from categorizing these contributions, I’ve made no further editorial additions. This post will become part of the guest posts category, because it was written by you.

Complete the sentence, “Behind every great EMT…”

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Litter Begets Litter

Here’s a little bit of applied psychology for you. In 1990 some researchers tried an experiment. People were handed a piece of paper in a local park while they were walking down a path. (A public service announcement to be exact.) After they walked past the leaflet handing researcher they then walked through an area where, unbeknown to them, the number of pieces of litter on the ground was being meticulously controlled.

You may be able to guess the results. If there were no pieces of litter on the ground, or only one piece, the subjects were unlikely to throw the unwanted piece of paper on the ground. After that, the likelihood of the person discarding the paper on the ground was exactly proportional to the number of pieces of paper already on the ground. The more litter already present on the ground, the more likely that the next person would also throw their piece of paper on the ground. It’s the law of social conformity.

Litter begets litter.

This isn’t new news. The 1990 research (Cialdini, Reno and Kalgren) was a repeat of similar research done in 1973 (Finnie), 1977 (Geller, Witmer and Tuso) and 1978 (Krause, Freedmen and Whitcup.)

How does this apply to you?

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207 Reasons to Stay Current

on Your Continuing Education

Perhaps you’ve already heard, starting July 1st, 207 EMT’s in the city of Boston will begin serving suspensions ranging from 45 days to 9 months for falsifying their training records and claiming that they had attended continuing education classes that they had not.

Now, to add a little bitterness to the whole thing, a few Massachusetts EMT’s have come forward to say that the suspensions are unfair. Instead of taking the suspensions with grace, serving the punishment and feeling fortunate to still have a certification, they are coming forward with some comments about the usefulness of continuing education.

Terry Urekew, an uninvolved bystander in the whole debacle, chimed in with this quote, “Give everyone a $100 fine and community service. Don’t take someone’s livelihood away from something that has no impact on whether or not we are better EMTs,” You can probably guess that a guy who writes a website with the subtitle, “Medicine moves fast…keep up.” is going to probably take issue with Terry’s assessment of the usefulness of keeping up on medical education. You’d be right.

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