I love posting articles controversial enough to warrant a disclaimer. Today I have the pleasure of bringing you another post by guest author Sean Fontaine. Sean is a graduate of Regis University and a Firefighter / Paramedic for The South Metro Fire Rescue Authority. He lives in Denver, Colorado with his lovely wife Oz and their two sons Jonas and Axel.
Today, Sean throws down the gauntlet on an issue that must be addressed by every emergency caregiver; the delicate balance between delivering objective, impartial medical care and the urge to interject our emotions into the often emotional drama that is emergency medicine. Can you make real emotional connections in the process of administering medical care, or does the emotional aspect of the job directly impact the effectiveness of your care? Some of us may address this dilemma only in our own private thoughts. Others may wish to publicly declare their position. To that end, here’s Sean…
Let me preface this post with the explanation that this topic comes straight from my discussions with paramedic school students and co-workers and the differing/agreeing viewpoints that resulted from those discussions. These are my opinions (not Steve’s) and I know full well that there are many of you out there that will disagree and some that will think I’m an insensitive ass. So be it, we’re here to listen to different viewpoints and think through them for ourselves, deciding in the process what our own thoughts truly are on a given subject.
The Argument: Your level of objectivity effects the quality of your patient care.
I contend that when we emotionally care about our patients we become subjective caregivers and as such render subjective care, transitioning to reactive rather than proactive medicine.
I have to give credit where credit is due. The British Heart Foundation recently released a public service announcement video staring tough-guy actor Vinnie Jones. (See Lock, Stock and Two Smoking Barrels, Snatch.)
This might be the most clever medical PSA I’ve ever encountered. The British Heart Foundation folks have figured out how to get ideas to spread in the 21st century. First, make them simple. Second, make them memorable and third, whenever possible, make them funny.
This is the kind of thing that people will post on their Facebook pages. Once they do that, you don’t need to distribute the idea any longer, people will do it for you.
I really enjoyed this video that was uploaded today over at EMS1‘s ParamedicTV. I’ve seen a few of these videos come and go over the years and I’ve even contemplated putting one together myself.
What I appreciated about this video was the focus on the commitment and compassion of EMS providers as well as the multicultural scope of the photos. Some of these videos get a bit over the top with the “hero”aspect of the job…a characterization that I’ve never been entirely comfortable with.
I think this video gets it right and I’d like to share it with you.
Here’s some good news for EMT’s studying for the National Registry exam. The development team at The EMT Advantage has partnered with the phone app design folks over at Code3Apps and put together a phone app that will let you simulate the NREMT Basic exam right on your cell phone.
Using the same authors that write the actual questions for the Registry exam, the NREMT Simulator allows students to simulate what it looks and feels like to take the National Registry exam. The simulator is different from other Registry study tools in a bunch of ways that EMT’s preparing for the exam will find insanely useful.
The phone app includes:
Questions pre-calibratd to National Registry passing difficulty
Subject matter that spans the entire National Standard Curriculum
Questions developed by the same individuals who write the Registry exam questions
Pass / Fail estimations in each of the six Registry subject categories
Detailed post-test feedback on user results with question break-down
You can pick up the NREMT Simulator for your Android smart phone in the Android marketplace right here. You can also find it on your droid by searching the marketplace for NREMT Simulator.
There is also a version available for the Kindle Fire. You can download any version of the app for $4.99.
Do you want to know if you’re ready to pass the National Registry exam? When you think you’re ready to tear it up, download the app and find out for sure.
“There can be no real freedom without the freedom to fail.”
-Eric Hoffer (American Social Writer)
But can we really? I mean, really fail. In the course of delivering emergency care can we completely fail?
I imagine that somewhere at the core of each and every one of us is a secret fear that the next call, the next major incident, the next patient contact might be the one where we fail. I think we all carry around with us the fear of a massive, public, ugly failure in the course of our care.
I say that because it’s entirely plausible that we will experience one of these failures in our careers. They happen all the time. They happen more frequently than we want to admit. And I would like to assert that we are better caregivers when we can put that fear aside.
What does your organization do to help resolve that fear? What does it do to feed it?
What your organization does to respond to critical failures in patient care will determine a lot about how free their personnel we feel to go out and practice good medicine. It’s worth thinking about.
Here’s a (fairly) simple calculation that you can use to figure out just how much fluid you should be giving to your burn patient. The Parkland formula is both simple and useful. It not only gives us a good general idea how fast we should administer that first bag of saline enroute to the E.R., it’s also a great reminder of an important fact of burn care:
Burn patient’s need lots of fluid. …How much?
Let’s review the Parkland Formula and figure it out.
The Parkland Formula was born in 1968 when emergency room physician Charles Baxter realized that his critical burn patients needed massive amounts of fluid in the first 24 hours of treatment to remain hemodynamically stable. Working out of Parkland Memorial Hospital in Dallas, Texas, he and his fellow physicians began experimenting to figure out a fast way to know just how much fluid was enough.
The result was the Parkland Formula. Used today almost universally, in burn centers across America and around the world, it has become a standard of critical burn care. And, yes, you can do it too. Don’t get nervous about your protocols, your local E.R. physician knows the formula.
The Parkland formula begins with a rough calculation of the patients total body surface area burned. That is to say, what percentage of the patients total body surface area is involved in the burn? To come up with that number we can use a few techniques. There’s the palm rule (or palmar rule) and the rule of nines. Feel free to brush up on both. We’ll wait.
OK, now that we know the total body surface area burned (TBSA) we also need to estimate the patient’s body weight in kilos. This is a relatively simple matter for just about everyone in the entire industrialized world…except within the United States. Here in the states we insist on teaching, learning and using the English standard system of measurement, which gives all of us in the medical field fits. There are a few good techniques for learning to estimate body weight in kilograms. You may want to review those too.
“The opposite of love is not hate, it is indifference. The opposite of art is not ugliness, it is indifference. The opposite of faith is not heresy, it is indifference. And the opposite of life is not death, it is indifference.” -Eli Wiesel (Holocaust survivor and author of the book Night.)
Sometimes we equate behaviors like anger and frustration to burnout. I often disagree. It isn’t the angry EMS worker or the frustrated employee that concerns me, it’s the indifferent one.
Anger is OK. Don’t be afraid of your anger or the anger of others. Anger means that we sense injustice and we care enough about it to want to take action. Angry people have done some great things. As long as we find respectful and appropriate outlets for our anger, it can be a very powerful emotion.
The same goes for frustration. Frustration is the birthplace of innovation. Frustration is often what we experience right before our breakthroughs. Frustration tells us that we are still ingarged and we haven’t given up.
Neither of these are burnout.
Burnout is the point when we no longer care. Burned out individuals may still see the injustice. They may still sense the need for a breakthrough. They may even be able to define it. The difference is that they no longer care.
Indifferent caregivers are dangerous. Avoid them like the plague. You have permission to feel angry. You have permission to feel frustrated. You never have permission to be indifferent.
If you find yourself at a point of indifference, it’s time to move on.
My latest Remember Two things video is posted over at EMS1.com. In this episode I discuss a crucial moment in patient care that is often overlooked. I’m talking about the moment we say goodbye to the patient after we’ve dropped them off at the hospital or their designated destination.
It’s an important moment because it’s an opportunity to make a very real, human connection with our patient and leave them with a positive impression of their experience with us and our service organization.
A Simple BLS Intervention Could Have Saved Michael Jackson.
It’s true. If we’re to believe the testimony of Dr. Steven Shafer in the recent trial of Dr. Conrad Murray. You can find EMS1′s coverage of the story here.
Murray was Michael Jackson’s personal physician, who administered Propofol to Jackson on the evening of the musicians death. Apparently, Dr. Murray never tried any of the BLS airway maneuvers that could have opened Jackson’s airway and allowed him to start breathing spontaneously. (Presuming his respiratory drive was still intact.)
Shafer testified, “Either a simple chin lift, just that alone, or an oral airway to move the tongue out of the way might well have been all that was required to save his life.”
Any kid who has ever drank a Slurpee too fast on a warm day, and found themselves shivering and chilled, knows that cold fluids can be remarkably effective at cooling the human body. I had this leason reinforced while I was working as a consultant for a bio-tech company. The company was looking for methods to induce and maintain therapeutic hypothermia.
I can disclose much about the different methods and results that the engineering team experimented with, but I will tell you this, if you want to drop someones core temperature fast, nothing is quite as effective as a quick, two litter bolus of cold saline. This is why most therapeutic hypothermia protocols begin by inducing hypothermia, not with some fancy cooling blanket or external cooling device, but an infusion of 37 degree saline.
With that thought in mind, how important should it be to keep the saline we infuse into our patients whom we want to keep warm at something close to body temperature? I hadn’t really given the question much thought until I got an email from Scott.
Scott’s one of those SWAT medic types. He works with his local SWAT team to provide on site medical interventions if the need arises. Scott had an interesting experience with an accidental infusion of ice cold saline. I’ll let Scott take it from here:
Advantage
