A Guest Post by Sean Fontaine
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.
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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.
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True Story…
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.
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“In Germany they first came for the communists, and I didn’t speak up because I wasn’t a communist. Then they came for the Jews, and I didn’t speak up because I wasn’t a Jew. Then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist. Then they came for the Catholics, and I didn’t speak up because I was a Protestant. Then they came for me – and by that time no one was left to speak up.”
- Rev. Martin Niemoller
Yesterday an Action Care ambulance covered my station while I was at a training. Action Care is the local private ambulance service. I know, the name always seemed a little silly to me. If a super hero ever created an ambulance service, he would most certainly call it Action Care. I joke about the name, but they’re the real deal. If you’re going to work as a private service EMT, you could do worse than Action Care. And if that doesn’t work out, there’s always the medical billing and coding field.
I’m glad we have Action Care. They help cover our district when we are low on resources. They are always professional and polite on scene. They give good care.
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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 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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I’m going to make an important point and I need you to pay attention. That sentence, the one I just wrote. The one about saying something 
important. That was a redundant statement. And it undermined your sense of my credibility as a blogger and an EMS educator. No really, it did.
Not in a huge way. Not like if I had said something that you knew to be completely false, or got all wishy-washy, namby-pamby about some critical issue regarding your patient care. But it made you doubt my sincerity just a little. Somewhere in your subconscious you thought, “If it’s important, why not just say it?” You questioned why I felt the need to preface my important thought with a statement declaring my own thought important.
It’s as if I doubted my own credibility.
So why shouldn’t you doubt it too.
Right?
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I didn’t draw the graph at right. It was made by a woman named Jessica Hagy over at www.thisisindexed.com. Jessica is not in the medical profession. She draws her observations about the world on index cards and posts them online.
She also has a long and growing list of blogging awards from around the world. Mostly due to her brilliantly irreverent style and her ability to make social observations that resonate with people.
Like this one.
It’s a sad but true observation. For some reason, it seems like many medical personnel have an interesting combination of helpfulness and jerkiness. Why do you suppose that is? I’ve thought a lot about that over the years.
I think a friend of mine, Steve Brien put it best when he said, “Some of us still have a lot of us still in us.”
Our profession is about the patient. It’s not about us. Remembering that simple fact, and keeping it at the forefront of our thoughts, isn’t as easy as it might seem.
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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I don’t handle the card much anymore. It stays inside a plastic sleeve in my planner. The edges are worn and the words are faded. It wasn’t printed on kind of paper that travels well in a wallet for twenty plus years. But it’s been worth carrying. It is, quite simply, the ultimate EMS protocol.
I don’t read it often. I’ve read it enough times over the past two decades to have it pretty well memorized.
It’s my STAR CARE card.
I got it back when I was a paramedic student at Baystar Ambulance in San Mateo California. It was 1992. I always believed the original author was none-other-than EMS guru Mike Taigman. Mike had signed on to be the quality care guy at the fledgling service and I knew the cards had originated in his office.
The idea was simple. We can’t write a policy for eveything you may encounter in the field. Instead, use this guideline. If the decision you’re about to make passes these eight tests, we support you. NO matter what. Come hell or high water … we have your back.
It’s brilliant really. It’s the policy to end all policies. It’s the grand daddy algorithm. It’s the ultimate protocol.
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