The Chronicles of EMS

In case you missed it, something big happened in EMS over the weekend. Last Friday night EMS folks from around the world gathered in San Francisco for the premier of the reality series The Chronicles of EMS.

If you haven’t seen the first episode yet, you can find it right here. I strongly encourage you to take 20 minutes out of your day and watch it right now. This series and the individuals who surround it are worth watching not only for what they are doing, which is incredibly cool, but for what they represent.

The Chronicles of EMS isn’t just an extremely cool EMS documentary. It’s a milestone. It’s representative of a shift in the conversation about what EMS is, what it’s supposed to be and how we’re going to help it evolve. The conversation about the future of EMS is shifting away from the policy makers and mainstream EMS media and becoming guided by the individuals on the street who are doing the job each day. It’s an interesting and powerful shift.

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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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Regarding The Duty To Act

A while back, when I wrote about the duty to act, I emphasized the idea that the duty to act only extends to “on-duty” medical personnel. In fact, my exact words were,

“If you are a trained medical professional and you are acting with an expectation of compensation you have a duty to act appropriately and within the scope of your training when called to assist with an emergency situation.”

I figured I should emphasize the idea that trained EMTs don’t have a duty to act when they aren’t being compensated for their services. This seemed to be the point of greatest confusion. I never thought much about making it clear that while you are on duty, working as an EMT, you are required to act.

I know … it seems painfully obvious. I thought so too. But over the past few weeks, there have just been a slew of stories that seem to fly in the face of the obvious.

First, there was the strange story of the UK paramedic who watched his EMT partner deliver a non-breathing child, didn’t call for any assistance, then watched her try to resuscitate the child. To his credit, he did drive her to the hospital while she continued the resuscitation attempt in the back.

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The C-Spine Immobilization Controversy

C-spine immobilization is not a benign procedure.

It’s not something that’s always worth doing “just in case.” It’s not risk free, comfortable or even practical. And, now, recent research from the Washington University School of Medicine suggests that it may not even do such a good job of keeping the patient’s head still.

Does anyone else agree that we’ve seen enough bad news about c-spine now that we can stop the massive overuse that plagues our industry? Can we start evaluating people and deciding who does and doesn’t meet criteria for spinal immobilization. Please?

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Are All Aspirin Created Equal?

“I took an Aspirin when I started feeling the pain.”

Close to a decade after the Aspirin for chest pain idea hit the main-stream, more and more folks are medicated themselves at the onset of chest pain. But are all Aspirin created equal? Does chewing make any difference in the rate of absorption?

No … and yes.

A recent study out of the University of California, San Diego took 14 healthy volunteers and feed them a moderate dose of Aspirin on three separate occasions. First they were asked to swallow adult size tablets, then they were asked to chew adult sized tablets and last they were asked to chew children’s chewable Aspirin tablets. After each administration the volunteers had blood drawn at set intervals. The results were predictable, but telling. After swallowing the adult tablets, 6 of the 14 volunteers had no detectable levelsof Aspirin in their system 45 minutes post swallow.

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Chest Pain: Is EMS Really Best?

Short answer: Yes.

Score one for EMS. A study published last January in the American Heart Journal evaluated transport and treatment times of patients who called 911 for their chest pain and patients who sought private transportation.

They found that patients who transported themselves to the emergency room arrived at the hospital in 35 minutes while patients who called 911 arrived in 39 minutes. (On average.)

Hold the phone. Before you tell grampa to forget the phone call and jump in the car, consider this; The study also concluded that the patients who dialed 911 received initial stabilizing treatments faster AND definitive treatments faster as well.

Those who called the ambulance received initial care like oxygen, aspirin and nitro in approximately six minutes as opposed to the self transporters who took 32 minutes to receive these interventions.

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Tulsa EMS In The Classrooms

Most of us have been there before. A puking, nearly unconscious teenager on our pram. All the predictable problems; airway issues, responsiveness issues, behavioral issues. When kids learn the hard lessons about alcohol and drugs we’re often the ones who get called in to clean up the mess. And, as tiring as the routine gets, we do what we can.

We protect the airway, administer our oxygen, start the IV, monitor the capnography, pay attention to the heart rhythms, the whole kit-n-kaboodle. (You may use another term … that’s just me.) The subtleties of treatment change with level of certification and protocols, but the call runs remarkably the same.

Some medics is Tulsa, OK decided that we run this call far to often and they got the bright idea to see if they could change that dynamic. Today in high school classrooms around Tulsa EMT’s and Paramedics are taking their kits and prams into the classrooms to talk to teenagers about just what it’s really like to be laying on that pram after an alcohol or drug use mishap.

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How To Make Sure Your Hand-off Reoprt Gets Heard

“But … It Was In My Hand-off Report“

Every EMS responder who delivers patients to the emergency room has experienced the frustration of feeling like the ED staff didn’t really get the whole picture. You came in, you told the story and you said your goodbyes, but somewhere along the way it felt like there was a disconnect.

Now, some excellent research out of Harvard tells us exactly how much of the EMS hand-off report is really making it into the patients chart and being used in the clinical decision making and care of the patient. I’m sure the study findings are going to have a bit of a “duh” effect on responders who give routine hand-off reports to ER staff, but it is nice to feel that your impressions have been validated by some objective measure.

Researchers decided on 16 prehospital data points that were considered to be significant in effecting patient outcomes in level one trauma activations. Then they had a panel of trauma physicians watch videos of the EMT-to-trauma-team hand-off reports and checked off when the data points were actually communicated in the verbal hand-off report. Next they checked the patients medical record to see how many of these data points had been recorded in the patients chart.

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Seniors Get Nude To Protect Local Volunteers

Did you see that?  That’s what I’m talking about.

Recently I took a bit of flack here for a suggestion I made. A New Jersey volunteer squad was having their funding cut by the governor and there was a lot of online press with the squad members explaining how devastating this would be to the community and how essential their service was to the sick and injured.

I made two observations:

1.) If you are certain that your service is essential, the best was to make your point is to call the governors bluff. Start shutting the doors on certain days. … Stop providing the service.

2.) If the community feels your service is essential they will rally around you. No need to shout your own praises, they wil do it for you.

I took some e-mail heat from New Jersey volunteers explaining that the public can’t be trusted to understand what’s truly good for them. The idea of not responding to an emergency was reportedly reprehensible and the fear that the community wouldn’t understand what they had lost until it was to late was evident.

I disagreed. I still disagree. And to further stand by my claim, I give you The Pinnup Boys of Atlantic Shores.

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The Oklahoma State Trooper vs EMS Mess

This has gone on long enough and gotten big enough that I feel compelled to say something about it. By now I’m sure you’ve seen and heard all about the Oklahoma State Trooper / EMS roadside circus.

First we had the cell phone video of an upset family member recording an odd looking scuffle between an Oklahoma State Trooper and an ambulance crew on the side of the road. It starts with a narrative by the family member and ends with the ambulance dude in a disturbing looking choke hold.

Then the driver of the ambulance went public and started giving news interviews, stating he was compelled to do so by the statements of the trooper in his report. Somehow he felt that the media spotlight would be the best place to get this off his chest. He was followed by his partner, calling for the officers badge on The Early Show.

The OSP finally released the dash cam video showing an ambulance yielding appropriately to the officer and never taking the aggressive swing at the trooper as initially reported. Then the biggest clown of all chimed in when the OSP lawyer held a press conference to say that everything we saw on the tape was normal and appropriate except for the gross negligence of the ambulance crew failing to yield for a full 24 seconds. What?

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