The EMT Liability Pop Quiz

There really is a dizzying array of stuff we can do to get ourselves in legal hot water in EMS. I was considering a few this afternoon and I got this idea.

Let’s play a game. I’ll give you a whole list of scenarios and you match the legal transgression to the act. OK, that was a really boring and overly technical way to describe my game.

I’ll say what they did; you tell me what they did wrong. Sound like fun? I agree. Let’s begin.

Here are all the possible answers:

• Sounds OK to me
• Negligence
• Battery
• Abandonment
• Assault

Jot your answers down on a scrap of paper. I’ll be back on Thursday with my answers and the rationale behind them.

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Assessment and Scope of Practice

It’s never comfortable to be placed under a microscope. Especially when the dude looking through the microscope is The Rogue Medic, Tim Noonan. Tim’s a great dude, but he’s not the guy you want picking through your knowledge sock drawer. He’s thorough, he’s smart and he’s willing to analyze the details long after you and I have gone to bed.

If you don’t already read Tim’s blog you should. He’s a fantastic EMS blogger. That being said, I wasn’t terribly excited when he posted a comment on my post “I’m Only An EMT Basic” announcing that his comments on the piece could be found over at Rogue Medic headquarters.

For the record, my piece received nothing but kind handling by Tim. The question he chose to focus his lens on? Are lung sounds a part of the EMT scope of practice?

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The Illussion of Control

Part two of a two part series on scene presence. Part one is here.

While we’re talking about scene presence, I think it’s important to bring this one up. I’ve hesitated to talk about the illusion of control on the blog even though it’s a learning point that I invariably discuss with new students on the rig in the first one or two shifts. The illusion of control is deeply applicable to learning scene presence, but, quite frankly, it contradicts something I’ve preached here on The Spot for some time.

It contradicts my advice to always be authentic. When it comes to authenticity, the illusion of control is the exception to the rule. I suspect that some of my regular readers may have take issue with that. It’s OK, I’m a big boy. I can handle it.

In the world of scene management and scene control, the illusion of control is a metaphor for how we should respond when things don’t go the way we planned.

There is an awkward and embarrassing moment that we all have to deal with while running calls. It helps to think it over before it happens. If you’ve been in EMS for any length of time, it’s already happened to you. So let’s talk about it now. How do you react when you make a mistake during a call? What do you do when things don’t go as planned? How do you respond when you make an outright flub, guffaw or blatant error right there for everyone to see?

My answer, “The illusion of control.” Allow me to explain.

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The Med List: ACE Inhibitors

Today I’m starting a new series called The Med List. Once or twice a month, I’d like take a closer look at a single class of home medications and explore the medical implications for our patients who take these meds.

The patient’s medications list holds a wealth of information. Prescribed medications tell us about the patient’s medical history. They also give us clues to the patient’s possible current condition and presentation. Some medicines can better explain the clinical picture in front of us and others can be red flags regarding treatment options and the patients likely response.

Let’s kick off by looking a little closer at a class of medicines called Angiotensin Converting Enzyme Inhibitors. These meds are more commonly called ACE Inhibitors. Everyone calls ACE inhibitors ACE inhibitors in much the same way that  everyone calls International Business Machines IBM and everyone calls American Telephone and Telegraph AT&T.

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L.C.E.S. For EMT’s

Some of you who are familiar with wildland firefighting are already well versed in the safety acronym L.C.E.S. It was developed in 1981 and continues to be taught in wildland firefighting curriculum as a handy checklist of things we should have in place when operating in dangerous environments where conditions can change fast.

L.C.E.S. came about when retired U.S. Forest Service Superintendent Paul Gleason looked at fatal fires over the previous 20 years and identified the four elements most likely to save your butt when stuff goes really wrong. The acronym he created is simple and it works.

In wildland firefighting changes in weather and fuel sources can mean that the operating conditions can go from good to “everybody run” in the blink on an eye, so L.C.E.S. is practiced pretty religiously.  One area of EMS where I feel is has tremendous application is when we’re working in traffic on accident scenes. I’d like to see us EMS folks adopt the L.C.E.S. mindset any time we’re working in the street or on the roadside.

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To Walk or Not To Walk?

The Happy Medic (THM) recently posted a fantastic topic on his blog. I love diving into controversial decisions that we have to make every shift. Here’s one of those questions that we need to answer on just about every call. Should we walk the patient to the pram or carry them?

This is one of those things that we have no choice but to address in every system on just about every call. How to we get the patient to the pram? When is it OK to walk them?

It seems like this subject got rolling on Justin’s (THM) blog when EMS types from around the country started sending him feedback about his role in the documentary film, The Chronicles of EMS. He was surprised by the volume of comments about him choosing to walk patients to the ambulance.

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The Non-Conformists’ Guide is Here!

I’ve gone live with the book and newsletter sign up and it appears that everything is running smoothly. I’ve already had a half dozen sign-ups and the link has only been posted for a few minutes.

Thanks for your patience. This writing project took me nearly six months to finish. I had an idea of what I wanted this book to be and I wasn’t willing to stop until I’d succeeded.

The result is The Non-Conformists’ Guide to EMS Success. This is no pamphlet or power point slide show. This is 48 pages, almost 16,000 words, and chapter after chapter of compelling ideas designed to challenge the way you think about your job, your leadership, your life, and your role in EMS. And it’s all free.

If you’re ready to stop listening to me talking about it and get the book for yourself, just click the newsletter sign-up at left. The EMT Spot practices a strict, double opt-in, anti-spam policy. We’ll never reveal your e-mail to anyone, ever.

You’ll receive an e-mail confirming that you really did sign up for Splatter and the e-book. Once you click the confirmation link you’ll received your welcome edition of Splatter and the .pdf version of the e-book will be attached. It’s as simple as that.

The newsletter will also have an opt-out link at the bottom if you’d rather not be on the newsletter mailing list. (But I hope you’ll decide to stay)

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The E-Book is Coming!

OK, I can’t keep this to myself any longer. It’s time for the big announcement. With the final draft still in the mail from my editorial team and the final design still lacking a few details, it would probably be best to just keep this under wraps for a few more weeks, but I can’t wait.

My first E-book is scheduled for release on January 21st, one week from today. The e-book will be free and it will be available right here at The Spot.

The Book is called The Non-Conformists Guide to EMS Success. This book is the culmination of two decades of EMS experiences, mistakes, failures, trials, and errors that lead to my ultimate success. My goal was to write something that would be useful to EMTs at any stage in their career. And I didn’t hold anything back. This is my road map to finding true success and fulfilment in EMS work.

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What Is Ketosis Anyway?

The carb craze may be responsible for thrusting the term ketosis into the mainstream vernacular. Before that, it was a word you rarely heard outside of medicine. Before Dr. Atikins and the low carb evangelists came along, you could relegate ketosis to a power point slide in an occasional diabetes lecture and be done with it.

Now it seems like ketosis is the in-word with soccer moms and zone dieters alike. And, while its conceptual popularity has grown, there’s still a lot of misunderstanding floating around about what ketosis is and what it means for your body. Much like belly button lint and the popularity of boy-bands, the ketosis phenomenon is well known yet somewhat mysterious and difficult to explain. So let’s review.

If you don’t have time for the long answer, here’s the short and sweet version:

• Ketosis is the term for abnormally high levels of ketone bodies in the blood.
• Ketones are created when the body breaks down fat for energy.

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Don’t Forget To Ask The Patient

Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi

It was nearly two decades ago that I knelt on the floor before Sammy in the Santa Clara County Sheriffs booking facility. I remember him so vividly that it’s hard to believe so much time has passed. There was nothing exceptional about him. Handcuffed to the waiting area bench, he looked very much like you might expect a man high on drugs, being booked for petty larceny, might look.

Sammy felt like his heart was racing and, given his drug history, the officer thought that he needed a once-over before heading off to the county lock-up. I, the young, scared, mostly clueless paramedic intern was doing my best to evaluate him. Growing up in a quaint California suburb I hadn’t crossed paths with to many folks like Sammy. He, quite frankly, terrified me. My preceptors stood back and observed.

“Sammy did you do any drugs tonight?” I asked.

“Yeah, I did a speedball about an hour ago.” He casually offered.

I looked over at my preceptor Mark hoping for clarification. I got nothing. I looked back at Sammy and then again at Mark who smiled demurely. “What’s a speedball I asked?” Mark knew the answer but he had other ideas. He gestured toward Sammy. “Ask him. He’s the one who took it.”

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