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.”

Sadly, he’s absolutely right. What he didn’t mention was how common this error is among experienced caregivers. None of us want to admit it, but we do it. We ALL do it. In the stress of the moment we rush to our advanced skills and forget about our, seemingly lesser, basic skills.

It is this “ALS-saves-lives” instinct that causes providers to stand and watch an apneic patient while a paramedic prepares his intubation equipment.

It is the same instinct that causes providers to want to start IV’s on scene instead of transporting a sick trauma patient.

It is the same instinct that causes providers to stop good CPR compressions to look at the monitor, get the ET tube placed and push another round of ALS drugs.

It is the same instinct that draws us away from our good patient assessment skills to stare at the numbers on our monitor screen.

Apnea should never be a life threatening event in the presence of good, solid EMT skills. It’s true for EMT-Basics and it’s true for high-priced celebrity physicians. BLS skills aren’t basic. They are foundational.

Someone should have told Dr. Murray.

Authors Note: I’d like to thank Micah Gray from St. Louis, MO. for suggesting the idea for this post.

What do you think?: Should Conrad Murray be behind bars?

Read more news and views:

Medication Mistakes and Demotions

Should We Let the Cops transport Our Patient’s?

207 Reasons to Stay Current on Your Continuing Education

Regarding the Duty to Act

]]> http://theemtspot.com/2011/11/08/bls-before-als/feed/ 9 http://theemtspot.com/2011/10/17/chicago-fires-als-bls-conundrum/ http://theemtspot.com/2011/10/17/chicago-fires-als-bls-conundrum/#comments Mon, 17 Oct 2011 21:05:49 +0000 Steve Whitehead http://theemtspot.com/?p=4615 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.

First, Pete says that 911 EMD systems force the call taker to “Play God” by asking questions and determining the level of response appropriate for the caller. He likens this to “going to the doctor over the phone.”

What he fails to tell the reporters is that 21^st Century EMD is extremely accurate. Dispatchers don’t make “judgment calls” on a whim. They use a very refined system to produce a very accurate and predictable result.

Next, Houlihan explains, “It’s always better to have trained medical people view the person instead of making a life-or-death decision over the phone. It would definitely help [reduce] the city’s liability.” I say wrong, wrong and wrong. There are three misleading statements here.

The first one is, “trained medical person”. Pete is implying that EMT’s aren’t trained medical personnel. They are. And in a system like this one, where they actually get to provide primary care, they probably get pretty darn good at it.

The second falsehood Peter lays down is the idea of call takers making a, “life or death decision”. Remarkably few calls to an urban EMS center are life-and-death. For the ones where life is truly on the line, the difference between an EMT provider and a paramedic provider is remarkably small. Research does not support the idea that paramedic level care decreases mortality in any appreciable number of our patient populations. In some cases, paramedic level care may increase mortality rates.

If we’re ever going to get past the EMS era of send-everyone-all-the-time-to-everything we need to accept that we don’t need paramedics to show up every time someone calls 911. Fear based life-or-death language is inaccurate and makes it so much harder to move forward into the next phase of dynamic EMS systems.

Mr. Houlihan’s final misleading comment is that all paramedic systems “reduce liability”. That’s never been demonstrated anywhere that I’ve seen. This statement implies that once a call has been categorized as BLS, there’s no turning back or increasing the level of care. It suggests that trained EMT’s can’t initiate good BLS care, package the patient for transport and call in an ALS crew to take over care.

Come on now Pete. I call bull. I don’t know exactly what your political reasons are for wanting those BLS cars off the street, but you should know better than this. Sending ALS units to ALS sounding problems and sending BLS units to BLS problems is not akin to “playing Russian Roulette.” Trust your people.

And one more thing, If ALS responses are so important to you, you could just redeploy all those double paramedic units as single medic units and fix this whole mess tomorrow. It won’t save any lives, but it may calm all those fearful citizens you’ve been scaring with your stories of the BLS boogey man.

That’s what I think. What do you think? Leave a comment and join the fray.

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.

There are many theories as to why that happens.

Take care of yourself.

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.

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.

They discovered that the patients transported by police tended to be sicker then the patients who were allowed to wait for an ambulance. They also found that the people transported by the police were more likely to be gunshot victims. Both of those findings make perfect sense.

Finally, they found that, after they adjusted for the differences on trauma severity, there was no significant statistical difference between the patients transported by ambulance and the ones that took the ride in the police car. None.

I have two thoughts about this:

My first thought was that I was glad to see that the ambulance transport patient group didn’t have a worse survival rate that the police transport group. I’ve seen paramedics waste a phenomenal amount of time performing spinal immobilization and starting IVs when they should have been enroute to the E.R. My initial concern was that our ambulance patients might actually be found to have a higher mortality rate that the police group.

If the police transport group had a significantly higher survival rate, this could have been awful for us.

My second thought was that we could do better than this. We’re learning more and more about which interventions are useful and which ones are not. We’re doing a better job of education folks on how to save trauma patients in all three time windows. I think a day is coming when the idea of a police officer transporting a gunshot victim will seem absurd.

Unfortunately, today is not that day.

What do you think? Should we let the cops transport our penetrating trauma patients?

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.

Comfort

I like a boot to feel good on my foot. I don’t want them to feel good two years down the road, I want them to feel good right now. I don’t believe in suffering until I’ve worked in a good pair of boots. I like them to feel good right out of the box.

On this front, I think Magnum has a clear advantage in the field. I don’t know what they do and I imagine that it’s a carefully guarded trade secret, but these boots felt good the first time I put them on my feet. The arch support is unparalleled and the lacing really hugs your foot without biting.

Support around the ankle is top notch. I took the boots for a run around the drill ground one afternoon to see if i could get any rubs or hot spots. I got nothing (except a good workout.) I simply can’t make my feet feel bad in these boots.

One comfort negative I noticed was that, after several hours of wear, the upper edge of the boot wanted to press into my shin uncomfortably. While my feet still felt good, this was a bit of an annoyance that didn’t improve remarkably with wear. I was able to rectify the problem with a higher, bulkier pair of work socks.

On future models of the Elite Force, I’d like to see Magnum apply their trademark comfort-magic to the upper edge of the boot as well. I don’t imagine that the shin-dig would be a deal breaker for most folks, and the great news is that Magnum takes comfort seriously. If you put these babies on your feet and you don’t like anything about the way the feel, Magnum will take them back for up to sixty days. You have to admire a company that stands behind their products.

Durability

I’ve worn my Magnums for almost a year now and I’ve noticed very little wear. They look like new. The photos you see here were taken after a year of wearing the boots and they still look like they just came out of the box.

Water Resistance

My water testing consisted of an in-station, simulated rain test and a real world swift-water rescue course. The first test was performed out behind my station with a garden hose. I sprayed the boots down liberally to try to saturate the fabric and give my little piggy’s a soaking.

It didn’t happen. The Magnums shed a ridiculous amount of water without absorbing a bit. I was impressed. But really, how realistic is a garden hose? I wondered how well the Magnums would hold up in serious water while my feet were moving and I was working. To that end, I took them along to my swift-water re-certification class.

I first noticed some water in my boots about 25 minutes into throw-bag arrest practice. That means I spent 25 minutes, working hard, in and out of standing water, feet fully submerged, hauling in swimmers on ropes. It was probably 40 minutes into the exercise that I felt like I had significant water saturation within the boot. Even after water penetration, the boot remained comfortable and performed well.

Magnum accomplishes this remarkable degree of water resistance using what it calls ion-mask hydro-management technology. Water resistance is further improved by a unique lace eyelet design that keeps the laces on the top of the boot instead of between the tongue and the boot. It works.

Style

I’ll say it. They look good. To coin a phrase that you won’t find on Magnums website, the look kind of bad-ass. I could describe to you why I think that is, but just look at the picture instead. You know what I’m talking about.

Performance

Looks don’t mean anything if the boot turns out to be just another pretty face. In the performance category, this boot comes through in spades. And that’s where it really counts right?

Dry feet are nice. Comfortable feet are really nice. Pretty looking feet are great too. But you might as well throw the boots in the garbage if they don’t perform when it counts. Pretty boots are worthless if your feet slip out from under you while you’re carrying someone’s grandma down a staircase in the rain or you can’t dig in on an icy road in the middle of the night a feel confident.

I was very happy with this boots performance over the year that they were on my feet. The boots light weight and sticky Vibram sole give the wearer a feeling of confidence and agility. I wore them through the Colorado winter, shoveling snow and working on roadways. I wore them through the summer standing ankle deep in streams and hiking in on dirt trails. I climbed on roofs and stomped on burning Yucca plants.

These boots never failed me, and for that…I’m sold.

Conclusion

I give the Magnum Elite Force 8.0 an enthusiastic recommendation. I think you’ll be really happy with this boot. With a retail price of $160.00, Magnum’s Elite force line comes in at the upper mid-range of the market and I believe that they are a value for what they offer.

Most folks who’ve worked in EMS for a few years will tell you that it isn’t worth it to skimp on boots. With this boot, you’re going to like what you get. I know I’ll keep wearing mine for years to come.

Now it’s your turn: Do you wear Magnum boots? What do you think? What makes a great EMS boot?

Read More Stuff:

Are All Aspirin Created Equal?

Glucometer Errors

Just Call 911 – A Novel Idea

Chest Pain: Is EMS Really Best?

Understanding OPQRST

]]> http://theemtspot.com/2010/11/09/ready-for-duty/feed/ 4 http://theemtspot.com/2010/07/15/207-reasons-to-stay-current/ http://theemtspot.com/2010/07/15/207-reasons-to-stay-current/#comments Thu, 15 Jul 2010 16:20:48 +0000 administrator http://theemtspot.com/?p=3406 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.

Then there’s Kim, the state EMT suspended for nine months who protested, “The refresher course just repeats everything. We didn’t put you at harm.”  Uh, well, yes Kim, good point. But you didn’t not…not, put us at…safe? Bad grammar aside, Terry and Kim are glossing over a few important points about what they did.

If any of the Massachusetts EMT’s are still reeling in confusion over the unfairness of all this, let me offer up a few points of clarification for you.

1) You lied and cheated

There were two significant wrong-doings here folks. First there was the continuing education that you didn’t receive; The updates on protocols and changes to procedures like tourniquet use and CPR that you decided weren’t really critical to your understanding of your job. But then, there’s also the fact that you lied.

You work in a job where the community places great trust in you. They invite you into their homes when they are weak and helpless and they need to trust that you are morally sound. That means, when you say something, it’s true and when you do something, it’s proper. This was your greatest failure. Not your lack of knowledge but your lack of an appropriate moral compass.

2) You disrespected the EMT’s who work hard and follow the rules.

24,000 EMTs in your state managed to complete the requirements of continued certification without fabricating their training records. They followed the rues and respected the process. When you unilaterally decided to forgo your troublesome C.E. requirements you disrespected all of them.

This idea that, since you got caught cheating the system, you should be slapped with a small fine and allowed to continue is insulting to the EMT’s who could have also payed a little money to not go to classes but opted to follow the rules instead. Your punishment needs to be stiff enough that the EMT’s who worked hard can feel rightfully vindicated for following the rules.

3) You disrespected our profession.

This one burns me the most. I’m just astounded at the hubris in your statements. It’s as if you feel like everything you needed to know about medicine was covered in the 140 some-odd hours of your EMT class and now you shouldn’t be troubled with additional knowledge and skills.

What harm could possibly come from allowing you to continue in your work unhindered by advancing knowledge and skills? Well, quite a bit actually. The knowledge you were given barely scratched the surface of emergency medicine. You’re an EMT. You should be hungry for more knowledge. You should be eager to learn more about the medical challenges you’re bound to face in the future.

Perhaps you think your punishment was unfairly harsh. I disagree. I think the system that you continue to openly disrespect was unusually kind to you. The next time a news reporter calls asking for your your opinion, you may want to try, “No comment.” as a response.

What do you think?: Were the Massachusetts punishments unfair?

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.

What’s in it for you? How about round trip airfare to any future shooting location of the new show and a chance to be on the set with the crew and part of that episode. Pretty big eh? You also get a brand new, ultra-cool Apple iPad to play with on the plane. That sounds pretty big to me. What are you waiting for? Put your thinking caps on and get naming.

“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.

In other parts of the blogsphere, David Konig revived an old Dave Berry video that was made using the EMS photography of Jeff Forster back in my days at Pridemark Paramedics. (Hint: You can find me in the video at 4m 54s. I’m assessing a lady’s pupils – figures.) Greg Friese of Everyday EMS Tips rang in EMS week with a whole series of videos. Buckman of Gomerville fame penned a poignant examination of his inability to suffer the foolish, and the problem with slippery babies. Jaramedic attended EMS on The Hill. Chris Kaiser told us about a party and a fall and a death that all happened in an instant. Epijunky said a prayer to the patron saint of medic students. Tom Reynolds points out another example of why it’s always easier to blame us. Rogue Medic took another, well deserved, shot at Dr. Andrew Wakefield and Happy Medic, Justin Schorr asked us to reconsider our idea of liability.

In EMS news, the disciplinary proceedings go on and the debate continues in the death of a Pittsburgh man who waited 30 hours for an ambulance, called 911 a dozen times and then, tragically, died. A former DC EMS responder confessed to stealing, not one, but two heart monitors from his employer and then trying to sell them to a different EMS organization. Virginia paramedics will be some of the first to stop sending ambulances for tooth achesand perfume in the eyes calls. Marianne Cavanaugh-Wozniak was just 45 minutes into her new job when she saved a man’s life. An Atlanta man who weighed well over 300 pounds, had a history of high blood pressure and coronary artery disease, who was unconscious, who was then violent and combative, who was then able to fight through several TASER charges, has died. Of course…everyone is blaming the TASER.

And the EMS padcast’s play on. This month, the EMS Garage went after pain management and c-spine. The Educast sorted out the differences between Canadian and American EMT education. The Medicast took on Calcium Channel Blocker Overdose and The GenMed Show talked about their recent trip to capitol hill.

That should be plenty to keep you busy while the EMS industry churns onward into June. We’ll be right back here to tell you about it soon.

Read more roundups:

The April EMS Roundup

The March EMS Roundup

The February EMS Roundup

The January EMS Roundup

The December EMS Roundup