BLS Before ALS

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.”

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Chicago Fire’s ALS / BLS Conundrum

This morning I was doing two of my very favorite things, sipping on a fresh cup of home-roasted coffee and scrolling through the EMS1 news feed, when I came across a story about The Chicago Fire Department trying to get rid of its two tiered system and go to all ALS ambulances.

Don’t worry, I’m not going to launch into a big discussion about single tier vs. two tier ambulance deployment or fire based vs. private ambulance service. I believe that different systems across the nation require different deployment models and, unless you are very familiar with the system you’re talking about, it’s really tough to say which model is ideal for that system.

Put briefly, Chicago Fire can figure out what model of response is going to work best for them.

What really burned me about this article though were the quotes from Pete Houlihan, EMS director for the Chicago Firefighters Union. Houlihan implies that EMT level providers are untrained medical personnel and he likens sending them on medical calls, unassisted by paramedics, as “playing Russian Roulette” with the citizens.

If I were an EMT working in Mr. Houlihan’s system that would piss me off. I’m not an EMT (Basic) and I don’t work in Chicago and it still pisses me off. I know I shouldn’t get to riled up about anything politicians say, but for the record, I’d like to correct a few of the misleading statements in this piece.

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Medication Mistakes and Demotions

A few days ago, EMS1 reported that a Tennessee paramedic had been demoted for administering an incorrect medication to a patient. I have mixed feelings about this and I’d like to know your thoughts.

My first thought is that we can’t race to judge if the discipline was warranted or appropriate in this specific circumstance. As always, in incidents like this, only a rare few people actually know the whole story. None of us can speak to the paramedics experience, his thought process, his history within the organization or his reputation. It is unlikely that any of us will ever know whether this was an isolated event or a problematic trend.

Having said that, I always have reservations about punitive responses to honest medical errors. I just think that they aren’t the right way to solve these types of problems. Human beings error. As long as humans carry out the work of medicine there will be errors. They are indeed inevitable.

Once we make peace with this idea, we can go about the real business of reducing errors to an acceptable minimum and always striving to reduce the number of occurrences and the harm done with each error. That’s easy for me to say. And it’s probably easy for a lot of folks to believe, until a paramedic makes a high profile error like this one and the family’s, facilities and media are clamoring for a response. Then discipline seems like a good idea.

Here’s the rub. Dicipline doesn’t seem to do anything to reduce or prevent the next error. In fact…discipline may make the problem worse.

It’s an interesting dilemma. I’d like to hear what you think.

Fact: EMS Workers Die Younger

Emergency responders have a 35% higher risk of dying from heart disease.

There are many theories as to why that happens.

Take care of yourself.

The Zoll Ascend to Leadership Summit 2011

Where will you be May 9th through the 13th? I’ll be at the Zoll Ascend to Leadership Summit in Denver, Colorado. If you’re looking for a conference in the mid-west this spring, you might want to give this one a look.

The Zoll conference isn’t just a gathering of Zoll users talking about the latest monitoring devices. The schedule of presentations at this years conference covers a wide array of subjects from clinical topics to EMS leadership.

Have you noticed how many of your favorite EMS blogs and websites are sponsored by Zoll Medical Corporation? There’s a reason for that. As technology becomes a larger and larger part of what we do in medicine, Zoll Medical is consistently positioning themselves not only as an industry leader in medical technology, but as a thought leader as well. If your interested in knowing what the future holds for EMS, I’d recommend you start paying attention to what Zoll Medical has to say.

You might want to start by attending the conference. I’ll see you there.

Should We Let the Cops Transport Our Patients?

You’ve heard that we may be harming our patient’s by wasting too much time doing interventions like spinal immobilization when it isn’t necessary right?

You’ve probably heard that we may be harming patients with overly-aggressive fluid resuscitation.

You may have heard that we do a poor job of bleeding control.

Maybe you’ve been told that you use poor sterile technique.

Or you’ve been admonished that you let your trauma patients get too cold.

When you’re all done getting beaten up over your trauma care, you might think to yourself, “Well heck…why not just let the cops throw people in their cars and take them to the hospital without any EMS  intervention at all?

Actually, that’s exactly what one major U.S. city did.

Over a decade ago, the city of Philadelphia recognized that some trauma patients were being forced to wait too long for an ambulance to arrive. The city authorized police officers to transport penetrating trauma to the E.R. in the back seat of their squad cars. No oxygen, no IVs, no fluids, no bleeding control, just a really fast ride to the emergency room.

In December of 2010 a research team from the University of Philadelphia decided to examine this practice a bit more closely to determine of patients were being done a disservice by being thrown into police cars instead of waiting for the medical professionals. They found a few interesting things.

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Ready For Duty

The Magnum Elite Force 8.0 Boot Review

I should probably disclose, right here at the start of this review, that I’ve always been a fan of Magnum boots. My first pair of real EMS boots were Magnums and…well, I guess you never forget your first.

While I’ve remained a fan, I haven’t been the most loyal customer. Through the past two decades I’ve worn just about whatever boot seemed to be in style or recommended or available at my local uniform store. I know. I’m not proud of it.

That’s why, when Magnum offered to let me test drive a pair of their new Magnum Elite 8.0 boots, I jumped at the chance. I was curious to get a pair of Magnums back on my feet and see if they still felt as good as that first pair. I was also willing to put previous biases aside and pay Magnum the proper respect by giving the Elite Force an honest to goodness, full-fledged, no-holds-barred test run. Here are my five essential elements of a quality EMS boot and how the Magnum Elite Force 8.0 measured up.

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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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Name The Chronicles Contest

If you subscribe to splatter (The twice monthly newsletter of The EMT Spot) you already knew that there was a big announcement coming today. You’ve just been standing by for the nitty-gritty details. what can I say? Sometimes it’s nice to have the inside track.

If you don’t get Splatter you should really consider signing up by typing your name and e-mail address in the sidebar box. Then you can get the inside juice as well.

In any case, here’s the big news. The Chronicles of EMS is getting ready to go big time. They’re pitching this show to everyone from The Discovery Channel to Oprahlooking for a network. One piece of feedback they’ve been getting is that the show needs a new name. The Chronicles of EMS – The Reality Series just doesn’t slide off the tongue the way TV producers like.

This is where you come in. This is where you get to take part in the biggest contest in EMS blogging history. Here is your chance to name the new reality series. If you think you have a better name for the show click here and go to the chronicles website for information on how to enter. You can also go here for all the rules and official stuff.

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The May EMS Roundup

“The worlds favorite season is the spring. All things seem possible in May.”

- Edwin Way Teale

As the days grow longer and the nights grow warmer here in Colorado, I feel the rush of summer on the horizon. Indeed all things may seem possible, but the first half of this month seemed consumed with podcasts and webinars. Then I remembered what I always yell to the first base runners on my daughters softball team, “Finish strong!”

I started the month by asking for a few Handover submissions. (And I got them.) I also told you about a few upcoming free webinars for National Registry skills and developing patient rapport. (Thanks for joining.) Then we had a guest post by EMS educator extraordinaire Jim Hoffman all about burnout and rebirth and I speculated about folks who push the self destruct button on their careers. Then I kicked off a new series in an effort to bring you the ultimate guide to EMT vital signs. To that end, we dissected the pulse and the blood pressure. I made good on my promise to bring you The Handover Blog Carnival and that brought us here. Strong indeed.

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