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.
My latest Remember Two Things video is up over at EMS1. At EMS World last year I gave a 90 minute presentation about sepsis for EMS providers. This video answers the most essential question from that lecture in about four minutes.
The question: What can EMS providers really do to reduce mortality rates in sepsis patients?
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.
Chances are, you’ve probably heard about the new trend in synthetic cannabis products either from your local news media or from your ongoing EMS education. Over the past few years, these products have been increasing in prevalence around the US and in Europe. But what are these products anyway? Are they cannabis or not? Are they legal to posses? Are the effects similar to traditional marijuana?
Here’s a quick rundown of what EMS folks should know about this new and growing trend in street pharmacology.
Synthetic cannabis products have a variety of street names including Spice, K2, Herbal Incense, Potpourri, Barely Legal and Kronic. It is frequently sold under the classification of an “herbal smoking blend” and some head shops and online retailers have attempted to skirt the ongoing tide of new regulations by selling the products as legitimate potpourri or plant food with the warning, “Not for human consumption.”
What is it really?
These products are all various dried organic (plant) compounds that are laced with a synthetic cannabinoid chemical that is designed to mimic the effects of cannabis in the body. Many of the products claim that they are a natural blend of legal herbs and spices that combine to give the user a legal and cannabis free high. Investigations into the contents of the products reveal that most of the herbs listed on the product packaging are not truly present in the product and that the often unidentified organic material in the product is laced with one of five common synthetic cannabinoids. (While there are over a hundred known synthetic chemical cannabinoids, these products tend to contain cannabicyclohexanol, JWH-018, JWH-073, CP-47,497 or HU-210.)
There’s something about the patient in labor that makes my palms sweat. I’m not alone. Most of us EMS folks get a little anxious at the idea of delivering a baby. Obstetrical calls can go very right and they can go very wrong. The stakes are high.
Here are a few things to consider before you run your next obstetrical call.
1) At full term, pregnant females have a heart rate 10-15 beats per minute faster than when they were prepartum. (Psst…Before they were pregnant.) They also have 25%-30% higher stroke volume and 30%-50% higher cardiac output.
2) Pregnant females will tolerate significant blood loss before they become symptomatic. Once they are symptomatic, they will decompensate rapidly.
Since the beginning of The EMT Spot, there has been one question that has dominated my e-mail in box. It goes something like this:
Hi Steve,
Thanks for the website. I was searching around on the internet for information to help me in my EMT class. I read a bunch of your articles and it’s great that you put all this information out there for new EMTs like me. I’m graduating from my EMT class in [Insert time frame between one and six weeks] and then I’m off to take the National Registry test. What advice do you have for me on getting through the test? What can you tell me about the testing format? I hear that it’s [Insert common rumor or misconception here.] Do you recommend any study guides or other resources?
Thanks for your help,
[Insert future EMTs name here]
Since The EMT Spot started three years ago, I’ve received this e-mail one or two times per month. Sometimes I responded personally. Sometimes I just cut and paste a previous response. Along the way, my answer has changed. Here is the evolution of my response.
In 1996 I took a job about 40 minutes south of San Jose, California with a small mom-and-pop ambulance company. The service was named after the owner and had been serving a mostly rural area of northern California for a couple of decades before I arrived in town. They were, without a doubt, the worst ambulance company I ever served under.
The owner ran the place like a dictator. I started work the day after my interview on a dirty ambulance wearing an old uniform that was two sizes too large. My partner was the grumpy silent type. The station conditions were deplorable and the policies and procedures were down-right unethical. (As an example, the owner would frequently order crews to respond to scenes, after they had been canceled enroute, so that they could gather billing information from the caller.)
I worked at the service for about three weeks, then I left. I knew that nothing about that service matched with who I was as a paramedic and nothing I could do would ever change the two decades of tradition and old guard thinking that had brought them to where they were. Unlike my uniforms previous owner, I washed my threadbare shirt before I handed it back in. Then I hit the road and I didn’t look back.
Today we have a guest post from Sally Davison. Sally is one of the masterminds behind the website FireScienceDegree.com. If you’re looking for a degree in fire science, Sally’s site offers what just may be the most comprehensive, no nonsense resources on the inter-web.
Sally also knows her way around the EMT field and has some advice for new EMT’s preparing themselves for the prehospital environment. She welcomes your comments at sally.davison091@gmail.com Please give her a warm welcome.
There’s much more to being an EMT than just providing emergency medical care alone; in most situations, you are much more important than doctors and specialists because your timely response and actions help:
Save lives
Save limbs and prevent lifelong and debilitating disabilities
Prevent brain damage and other consequences that happen when first aid is not provided immediately
Prevent people from going into shock
Stop uncontrolled bleeding
There are many other ways in which EMTs are extremely useful, and because of this, most victims are grateful for and satisfied with your work. However, there are some occasions when you are called upon to do much more than just administer first aid or provide medical care.
It’s the week before the final exam and my EMT class is feeling the pressure. The two-hundred question final looms large on the horizon and, in less than a week, the students will need to perform five randomly selected skills stations perfectly. This is the task that has most of the students really feeling the heat.
So we do what we do every class. We practice and practice and practice. So there we were, gathered around in groups, practicing our National Registry skills sheets. That’s when Joey asked me the question that absolutely floored me. It floored me and annoyed me, but really didn’t surprise me. I’ve heard the question asked before in many different ways.
Joey finished up his medical scenario and I was giving him some feedback on his performance. He looked down at the fictional patient’s medication list that I had provided him and he shrugged his shoulders. “We don’t really have to know what all these mean right?”
I told him I didn’t understand. He mulled the thought over in his head and took another stab at it. “I mean…we need to write these down and report them to the doctor, but it isn’t important for us to know what they all do. (Pause.) As EMT’s. (Pause.) Right?”
The dispatch information was updated before we had even rolled our rig out onto the pad. Eye injury, no serious symptoms. Jodie shut down the lights and I informed dispatch that we’d be responding non-emergent.
Up stairs and inside the small two bedroom apartment, Samantha, our patient, was waiting on the couch, holding a hot compress to her swollen right eyelid. Mom worked calmly in the kitchen finishing diner for her other two children. Alan, Samantha’s father sat on the edge of his seat next to his daughter in a state of barely containable anxiety.
He had recently arrived home from work and his wife had informed him of the apparent infection in Samantha’s right eye. One look and he was on the phone to us. Now he breathed rapidly as he fumbled through a list of questions. What caused it? Could it damage her vision? Could she lose her eye? Could she go blind?
I cleared the engine to go back in service and sat down next to him. Over the next ten minutes we both explained what pink-eye was and how to take care of it. We talked about hot-compresses and how contagious the bacteria was going to be. We reviewed the typical course for such and infection. How to prevent it in the other kids. How likely it was that one of them already had it. And we discussed his plan for morning. (It involved asking a neighbor to drive them to a near-by clinic.)
Alan called 911 for pink-eye. And…(This part is bound to be controversial, depending on what kind of system you work in.) I never offered to take him to the emergency room. And he never asked.
