Okay, so I want to put this out there before I put out the final, edited version of the "Round Stretcher Discussion." I am so not advocating fire arms in the ambulance. At the same time, I didn't want to hear someone get all pissy because I didn't include guns in my list of things a Medic/EMT/Fire Fighter be allowed to carry to help with self defense.
So, if you'd like a snippet of the very first portion of our discussion, here you go.
MT: Thank you for participating in this "Round Stretcher Discussion." Topic for this week will be, "Should we as EMS providers and Fire Fighters be allowed to carry something to defend ourselves such as a side arm, taser, pepper spray, what have you?"
Medic Dolphine (MD): If I see anyone coming towards me with a gun, I'm liable to shoot them myself.
EMT Doodle (ED): Only if they provide the bullet proof vests and make the ambulance bullet proof...like the stuff they make the black boxes on airplanes out of bullet proof...
There you have it. Guns were taken off the table in the first two minutes of conversation.
Thursday, July 22, 2010
Saturday, July 17, 2010
A new EMS Debate...
Hopefully I can get people eager to read my next post series. By the way, I am currently living with two other EMS professionals. I will call them Medic Dolphine and EMT Doodle. We get together and have our own round table discussion, and they have graciously allowed me to post their comments about a given topic. This next round will be about....
"Should Paramedics, EMT's and Fire Fighters be allowed to carry a side arm/taser/mace/self defense weapon on them while they are performing their duties?"
I'm sure this will be the start of something awesome. Look for a post tomorrow regarding the conversation. I'd also like to hear from you...yes...you...on what you think about this topic.
Have Fun and Be Safe,
~Medic Trommashere~
"Should Paramedics, EMT's and Fire Fighters be allowed to carry a side arm/taser/mace/self defense weapon on them while they are performing their duties?"
I'm sure this will be the start of something awesome. Look for a post tomorrow regarding the conversation. I'd also like to hear from you...yes...you...on what you think about this topic.
Have Fun and Be Safe,
~Medic Trommashere~
Sunday, July 11, 2010
The Great Intubation Debate (Part 1)
First off, let me say two things. Number One: I am so excited as an EMS provider that Paramedics and EMT's alike (both ground based Medics, Flight Medics, and those who work in hospital) are concerned about something so important; Intubation. We are all well aware that there needs to be a system wide change in how Intubations are taught, handled, and "scored" in the field. Number Two: I have to say the posts on this subject that I have seen are excellent! Please don't take offense to me disagreeing with your post; if I didn't like the content and thought you were so way off base I never would've given it a second thought to even write a rebuttal.
Anywho, Rogue Medic wrote about Intubation Education. Go ahead and read it, it's very well written and has a lot of great points.
Now, RM states: We act as if the OR (Operating Room) is the only place that we can obtain good practice. There is no evidence to support this.
There is nothing to show that OR training is superior to morgue training and mannequin training, but we act as if the decreased availability of OR time is the only reason medics can't intubate competently.
The decreased availability of OR time is not the only reason medics can't intubate well, but it is a big one. When was the last time you saw a mannequin with a severe facial deformation? A trachea so anterior or posterior that no matter how hard you apply crichoid pressure or manipulate their head back to the point of turning them into a lighted Pez dispenser can you even get a glimmer of cords?
When was the last time you saw a mannequin with cords so discolored and raw from years of smoking unfiltered Marborlo 100s and the wracking emphasemic cough that has them looking more like raw pieces of hamburger, or little slivers of charcoal?
As for the morgue, I can honestly say that my state did not allow anyone below an RN into the morgue; I tried to get in. Also, yes, the Coroner may have done some sort of ER time when s/he went through med school, but what type of advice can you get from them on intubating a live patient? When was the last time they held a blade and tube in their hands and intubated something that wasn't already cold and stiff?
The OR/ER is the only place, in my opinion, to get real world intubating practice. You have someone who does nothing but makes people really sleepy, then makes them chew plastic all day long. You get the smokers, those suffering such severe kyphosis of the spine that you can't get the head and neck to go into the sniffing position, those with Mallampati scores no less than 3. You just can't get that on mannequins.
We act as if the only problem with the way we are teaching paramedic school is that the students are not learning. As if this is not a reflection on the teaching.
Teaching means providing information to students in a way that helps the students to understand. If the students do not understand, the teacher did not teach.
Unfortunately, Paramedic classes are made up of a multitude of students. You have those who have been through Medic class over a half a dozen times, if not more, those who have never been in the field...the ones who's ink isn't even dry on their EMT card before they hopped in class, the know-it-all's who have been in the field since before Christ turned water into wine and they're just doing class because they want to be just like their childhood hero's from Emergency!, and then the ones who are being medics for all the right reasons.
Now let us say that you have six of each of these students. The first six have been taught over and over again how to intubate on a mannequin, so therefore believe that they are "good" at it, and have done their required OR time to the point that the CRNA's know them by name. They're just doing whatever the good instructor/doctor/nurse tells them so they can move on and maybe pass the final this time
The Second Six: The Eager Beavers: They can barely hold the blade before they make a mess in their pants. Their whole EMS existance has revolved around this one golden moment that they tune EVERYTHING out just so they can put that blade between the plastic lips of the mannequin. They'll say "Yes! I understand!" just to put that blade in. Instructors take that as the newbie screwing up and they get some remedial training, but even then that may be taken as a grain of salt by someone who, once they get their first tube, no matter how badly they fudged it up, think that's the way to do it.
The Third Six: They've seen every Medic in the world intubate, so they claim. Most of these students will claim that they, as mere EMT's, had a blade thrust in their hands because the Medic had his hands ripped off/maimed or was incapacitated somehow, and they managed to intubate the haemophiliac great-grandmother of 30 who was on her way to church and was in an accident that turned her jaw to mush, but somehow, he intubated her perfectly. I seriously doubt they even pay attention during any of the lectures and get lucky when they sink a tube correctly.
The Fourth Six: The Baby Medics: These Medic Students may have seen an intubation, but were too busy focusing on patient care to really pay attention. They have the thought process, maybe even the mechanics, but are listening at rapt attention during the lecture, and are the ones seen staying after class to get help on how to intubate.
Also, everyone needs to remember that Medic Classes are taught by PEOPLE Usually they are Medics with years of experience who have intubated at least 3 people before they started teaching. They also have their own nuiances to make it easier for them to Intubate, but may confuse the hell out of those who are trying to learn them.
Intubation education does need to be overhauled. On scene is not the time to learn how to intubate through ecchymosis, through Le Forte Fractures, through junk in the airway, through anything else than what was given to them by the mannequins and instructors. OR/ER time is needed for the sheer fact that, live tissue responds a certain way. You can't get the same feel off a (really) dead person or a mannequin.
Pediatric Mannequins are even worse. I heard more times than not from my instructors: "If you can intubate the mannequin, you can intubate a live baby."
That's a lie. The first time I ever stuck a blade into a (deceased unfortunately) babys' mouth, I was amazed at how much it wasn't like a mannequin. Just the feel, how you had to manipulate the blade, everything. My first adult intubation was an elderly female who went into cardiac arrest. Her trachea was so screwed up from numerous throat surgeries that it didn't even look like a trachea. The vocal cords didn't look like cords; hell, there wasn't any white to be seen really. The occasional little sliver, but it looked like a brown crescent moon.
What needs to happen is EMS instructors need to try and create as many real world scenarios that they can. If that means taking an endotracheal tube, cutting it so it fits in the airway and looks like the throat is swelling. Yes, I know that they make Sim-Mans', but here is the price break down:
Sim-Man: 27,395.00$
ACLS Scenarios: 4,194.00$
The Peripheral Kit that makes it do all it does: 7,495.00$
The Compressor to make it breathe, swell, and bleed: 3,300.00$
Now, if you are a little stand alone community college, there's no way you can even pretend to pay for the Sim-Man, let alone anything else including mantience. Also, having used a Sim-Man before, it is realistic to a point. You still have the perfect Mallampati once you get through the trismus and ecchymosis. The swelling is so overdone that it doesn't even look real anymore and when the "swelling" goes down, it abates completely within moments and intubation is easy.
In closing, while the lack of OR time is not to blame for the lack of success of Intubation, the lack of "live practice patients" is. Paramedics and Paramedic Students need face time with real body parts in various states of trauma and disrepair. At the fire scene is not the time to see first hand just how bad airway burns can get.
Most of all, on scene is not the time to realize that your instructors were wrong, that intubating the baby mannequin is not like a real baby.
This goes out to the students and practicing Medics: Do what you need to do to learn how to intubate. Don't leave it up to your instructors, or feel as if you know everything there is to know. YOU are the only thing standing between a good, open airway, or a dead patient. Ask questions, find classes, whatever you have to do.
Instructors: Don't lie to your students. You may think you are making them more comfortable and easing their fears of screwing up, but in reality, you are placing bad ideas in their head. If you say it's easy, then those who screw up will give up too easily, and those who manage to get a tube will think that all tubes will be that easy. Be creative and do something to challenge your students in the airway portion of the class; you already make up fun and bizzare rhythm combinations for ACLS, and make PALS seem fun with how you mix up scenarios and present it.
Airway isn't the module to skimp on. Airway is not just about shoving things in peoples' mouths and noses and hoping for the best. It's about being competent and good at what you're doing.
Have Fun and Be Safe.
~M.Trommashere~
Anywho, Rogue Medic wrote about Intubation Education. Go ahead and read it, it's very well written and has a lot of great points.
Now, RM states: We act as if the OR (Operating Room) is the only place that we can obtain good practice. There is no evidence to support this.
There is nothing to show that OR training is superior to morgue training and mannequin training, but we act as if the decreased availability of OR time is the only reason medics can't intubate competently.
The decreased availability of OR time is not the only reason medics can't intubate well, but it is a big one. When was the last time you saw a mannequin with a severe facial deformation? A trachea so anterior or posterior that no matter how hard you apply crichoid pressure or manipulate their head back to the point of turning them into a lighted Pez dispenser can you even get a glimmer of cords?
When was the last time you saw a mannequin with cords so discolored and raw from years of smoking unfiltered Marborlo 100s and the wracking emphasemic cough that has them looking more like raw pieces of hamburger, or little slivers of charcoal?
As for the morgue, I can honestly say that my state did not allow anyone below an RN into the morgue; I tried to get in. Also, yes, the Coroner may have done some sort of ER time when s/he went through med school, but what type of advice can you get from them on intubating a live patient? When was the last time they held a blade and tube in their hands and intubated something that wasn't already cold and stiff?
The OR/ER is the only place, in my opinion, to get real world intubating practice. You have someone who does nothing but makes people really sleepy, then makes them chew plastic all day long. You get the smokers, those suffering such severe kyphosis of the spine that you can't get the head and neck to go into the sniffing position, those with Mallampati scores no less than 3. You just can't get that on mannequins.
We act as if the only problem with the way we are teaching paramedic school is that the students are not learning. As if this is not a reflection on the teaching.
Teaching means providing information to students in a way that helps the students to understand. If the students do not understand, the teacher did not teach.
Unfortunately, Paramedic classes are made up of a multitude of students. You have those who have been through Medic class over a half a dozen times, if not more, those who have never been in the field...the ones who's ink isn't even dry on their EMT card before they hopped in class, the know-it-all's who have been in the field since before Christ turned water into wine and they're just doing class because they want to be just like their childhood hero's from Emergency!, and then the ones who are being medics for all the right reasons.
Now let us say that you have six of each of these students. The first six have been taught over and over again how to intubate on a mannequin, so therefore believe that they are "good" at it, and have done their required OR time to the point that the CRNA's know them by name. They're just doing whatever the good instructor/doctor/nurse tells them so they can move on and maybe pass the final this time
The Second Six: The Eager Beavers: They can barely hold the blade before they make a mess in their pants. Their whole EMS existance has revolved around this one golden moment that they tune EVERYTHING out just so they can put that blade between the plastic lips of the mannequin. They'll say "Yes! I understand!" just to put that blade in. Instructors take that as the newbie screwing up and they get some remedial training, but even then that may be taken as a grain of salt by someone who, once they get their first tube, no matter how badly they fudged it up, think that's the way to do it.
The Third Six: They've seen every Medic in the world intubate, so they claim. Most of these students will claim that they, as mere EMT's, had a blade thrust in their hands because the Medic had his hands ripped off/maimed or was incapacitated somehow, and they managed to intubate the haemophiliac great-grandmother of 30 who was on her way to church and was in an accident that turned her jaw to mush, but somehow, he intubated her perfectly. I seriously doubt they even pay attention during any of the lectures and get lucky when they sink a tube correctly.
The Fourth Six: The Baby Medics: These Medic Students may have seen an intubation, but were too busy focusing on patient care to really pay attention. They have the thought process, maybe even the mechanics, but are listening at rapt attention during the lecture, and are the ones seen staying after class to get help on how to intubate.
Also, everyone needs to remember that Medic Classes are taught by PEOPLE Usually they are Medics with years of experience who have intubated at least 3 people before they started teaching. They also have their own nuiances to make it easier for them to Intubate, but may confuse the hell out of those who are trying to learn them.
Intubation education does need to be overhauled. On scene is not the time to learn how to intubate through ecchymosis, through Le Forte Fractures, through junk in the airway, through anything else than what was given to them by the mannequins and instructors. OR/ER time is needed for the sheer fact that, live tissue responds a certain way. You can't get the same feel off a (really) dead person or a mannequin.
Pediatric Mannequins are even worse. I heard more times than not from my instructors: "If you can intubate the mannequin, you can intubate a live baby."
That's a lie. The first time I ever stuck a blade into a (deceased unfortunately) babys' mouth, I was amazed at how much it wasn't like a mannequin. Just the feel, how you had to manipulate the blade, everything. My first adult intubation was an elderly female who went into cardiac arrest. Her trachea was so screwed up from numerous throat surgeries that it didn't even look like a trachea. The vocal cords didn't look like cords; hell, there wasn't any white to be seen really. The occasional little sliver, but it looked like a brown crescent moon.
What needs to happen is EMS instructors need to try and create as many real world scenarios that they can. If that means taking an endotracheal tube, cutting it so it fits in the airway and looks like the throat is swelling. Yes, I know that they make Sim-Mans', but here is the price break down:
Sim-Man: 27,395.00$
ACLS Scenarios: 4,194.00$
The Peripheral Kit that makes it do all it does: 7,495.00$
The Compressor to make it breathe, swell, and bleed: 3,300.00$
Now, if you are a little stand alone community college, there's no way you can even pretend to pay for the Sim-Man, let alone anything else including mantience. Also, having used a Sim-Man before, it is realistic to a point. You still have the perfect Mallampati once you get through the trismus and ecchymosis. The swelling is so overdone that it doesn't even look real anymore and when the "swelling" goes down, it abates completely within moments and intubation is easy.
In closing, while the lack of OR time is not to blame for the lack of success of Intubation, the lack of "live practice patients" is. Paramedics and Paramedic Students need face time with real body parts in various states of trauma and disrepair. At the fire scene is not the time to see first hand just how bad airway burns can get.
Most of all, on scene is not the time to realize that your instructors were wrong, that intubating the baby mannequin is not like a real baby.
This goes out to the students and practicing Medics: Do what you need to do to learn how to intubate. Don't leave it up to your instructors, or feel as if you know everything there is to know. YOU are the only thing standing between a good, open airway, or a dead patient. Ask questions, find classes, whatever you have to do.
Instructors: Don't lie to your students. You may think you are making them more comfortable and easing their fears of screwing up, but in reality, you are placing bad ideas in their head. If you say it's easy, then those who screw up will give up too easily, and those who manage to get a tube will think that all tubes will be that easy. Be creative and do something to challenge your students in the airway portion of the class; you already make up fun and bizzare rhythm combinations for ACLS, and make PALS seem fun with how you mix up scenarios and present it.
Airway isn't the module to skimp on. Airway is not just about shoving things in peoples' mouths and noses and hoping for the best. It's about being competent and good at what you're doing.
Have Fun and Be Safe.
~M.Trommashere~
Friday, July 9, 2010
So, in my daily parusal of the various blogs, I came across Ambulance Drivers' blog, and an article he wrote for EMS1.com. I'll wait right here, I promise.
Ready? Okay!
So, this topic has definately struck a (good) nerve with me. I will always be the first person to say that I don't have all the facts, but my opinion would be (insert opinion here). In the case of the PA Medics. I was in Pennsylvania during the snow storms, actually in Pittsburgh visiting family. We got easily 24 inches in about twelve hours, if not more in a shorter time. Heavy Snow Plow trucks and Salt trucks were stuck all across the city. I personally watched an ambulance attempt to get up a hill and continually slide down.
Now, for those Medics. First off, I do not condone leaving the scene of someone who is calling for help. In this instance though, I can see it and would've probably done the same. You have Medics who need to respond all across the city. Pittsburgh roads in many places are still made out of cobblestone and bricks, so even using drop chains won't help. Trying to extricate the victim out would've been another challenge. Sure, you could've used the Reeves stretcher like a sled, but now you could cause an even worse injury to the patient if the providers fell ontop of them. Asking the patient to meet them half way isn't irresponsible either. I would not have taken a stretcher up there...that's just asking for it to tip over.
All in all, while the comments over the radio were poor form, the medics in Pgh did the best they could in the disaster that occured.
On the other side of the coin, we don't see the good that happened. I don't think anyone heard about the other EMS crew in a Pittsburgh Suburb that, after wrecking their ambulance trying to get a patient to the hospital in the same blizzard, hopped out of the truck with their various broken bones and injuries, and carried the patient up the hill to the trauma center they were trying to go to.
Now that's dedication.
It's true, EMT's eat their own kind.
As I posted before about the death of my C-1. I was the head Medic on that call. We had several different departments from the area there trying to help out with the other patients and mine. The stuff that was said about my crew and myself after the call was abhorrent. I am trying to intubate, laying on my stomach on a completely dark bridge. The Fire Department didn't have the scene lights up yet, and all I have to see with is the little light at the end of my blade. One of the cops on scene refused to shine his MagLight in our direction for a few moments so we could get our job done, insistant on standing a few feet away smoking a cigarette.
Somehow in the confusion, the tube tamer got out of my reach, so I did what any self respecting medic would do; I held onto the tube in my bare hand while I sent someone to the truck for a new one.
The flack I heard for the months following drove two of my partners from EMS. We heard things like: It's their fault, you know. That Medic didn't have a tube tamer, and that killed 'em or That's what happens when you let a girl on the truck or my favorite one If I would've been there, I woulda saved him. Other comments about what drugs we did and didn't use, or the caliber of the training we had or didn't have, or how gender played a role in the outcome ran rampant through the EMS world.
We were all punished and admonished by our own, fellow crew members. I had to have another Medic ride with me for a few weeks afterwards because those in power weren't sure if I was "able to perform the functions of being a fully functional Paramedic." I had random members of the department show up on calls, and I even had calls jumped and taken away from me because of my "poor performance on an EMS call." When asked about my performance and what was poor, the answer given to me was, "Well, if you can't save a life, then you can't be a Medic."
Yeah, talk about a swift kick to the pretend balls.
So, long story short; Be nice to your fellow EMT's and Medics. Unless you were there, you don't know the full story. Good article, AD!
Now, I'm off to go fishing! Power Bait for everyone!
~M. Trommashere~
Ready? Okay!
So, this topic has definately struck a (good) nerve with me. I will always be the first person to say that I don't have all the facts, but my opinion would be (insert opinion here). In the case of the PA Medics. I was in Pennsylvania during the snow storms, actually in Pittsburgh visiting family. We got easily 24 inches in about twelve hours, if not more in a shorter time. Heavy Snow Plow trucks and Salt trucks were stuck all across the city. I personally watched an ambulance attempt to get up a hill and continually slide down.
Now, for those Medics. First off, I do not condone leaving the scene of someone who is calling for help. In this instance though, I can see it and would've probably done the same. You have Medics who need to respond all across the city. Pittsburgh roads in many places are still made out of cobblestone and bricks, so even using drop chains won't help. Trying to extricate the victim out would've been another challenge. Sure, you could've used the Reeves stretcher like a sled, but now you could cause an even worse injury to the patient if the providers fell ontop of them. Asking the patient to meet them half way isn't irresponsible either. I would not have taken a stretcher up there...that's just asking for it to tip over.
All in all, while the comments over the radio were poor form, the medics in Pgh did the best they could in the disaster that occured.
On the other side of the coin, we don't see the good that happened. I don't think anyone heard about the other EMS crew in a Pittsburgh Suburb that, after wrecking their ambulance trying to get a patient to the hospital in the same blizzard, hopped out of the truck with their various broken bones and injuries, and carried the patient up the hill to the trauma center they were trying to go to.
Now that's dedication.
It's true, EMT's eat their own kind.
As I posted before about the death of my C-1. I was the head Medic on that call. We had several different departments from the area there trying to help out with the other patients and mine. The stuff that was said about my crew and myself after the call was abhorrent. I am trying to intubate, laying on my stomach on a completely dark bridge. The Fire Department didn't have the scene lights up yet, and all I have to see with is the little light at the end of my blade. One of the cops on scene refused to shine his MagLight in our direction for a few moments so we could get our job done, insistant on standing a few feet away smoking a cigarette.
Somehow in the confusion, the tube tamer got out of my reach, so I did what any self respecting medic would do; I held onto the tube in my bare hand while I sent someone to the truck for a new one.
The flack I heard for the months following drove two of my partners from EMS. We heard things like: It's their fault, you know. That Medic didn't have a tube tamer, and that killed 'em or That's what happens when you let a girl on the truck or my favorite one If I would've been there, I woulda saved him. Other comments about what drugs we did and didn't use, or the caliber of the training we had or didn't have, or how gender played a role in the outcome ran rampant through the EMS world.
We were all punished and admonished by our own, fellow crew members. I had to have another Medic ride with me for a few weeks afterwards because those in power weren't sure if I was "able to perform the functions of being a fully functional Paramedic." I had random members of the department show up on calls, and I even had calls jumped and taken away from me because of my "poor performance on an EMS call." When asked about my performance and what was poor, the answer given to me was, "Well, if you can't save a life, then you can't be a Medic."
Yeah, talk about a swift kick to the pretend balls.
So, long story short; Be nice to your fellow EMT's and Medics. Unless you were there, you don't know the full story. Good article, AD!
Now, I'm off to go fishing! Power Bait for everyone!
~M. Trommashere~
Wednesday, July 7, 2010
Reply to Comments!
Medic 3: First of all, thanks for joining in on a good topic. I wasn't trying to say that Rogue Medic wanted to take it away, I was speaking about a certain part in his article that sparked my interest and I wanted to write about my own experiences. I'm all for taking it away from incompetent medics, hell, I watched a flight medic intubate a womans' stomach and proceded to try and ventillate her that way for the next three minutes until someone higher trained than I that he'd listen to stepped in and told him he FUBAR'd.
You are correct. Incompetent or "bad" medics are just asked to go back through non hands' on classes, or put back to something we at home called 'Mother-May-I?' status where we'd have to call our command doc to do anything other than BLS skills. Neither one of those solves the problem though. How is it going to change how I do my IV/Intubation/whatever ALS skill I want to do? Sure, I'll be using my ALS powers responsibly because I have a doctor telling me when and when not to do something, but it's not going to change the mechanics. The doctor isn't there to hold my hand and show me what I'm doing wrong to facilitate a good intubation.
Back home they also looked at the use of an "alternate" airway as a failed intubation. Per our protocols, unless you use CPAP, the other airways are considered a last ditch effort. On the computerized trip sheets, the only way you can show that you used something other than intubation is if you state that you had an unsuccessful intubation. I know of a medic who actually got dropped back to "Mother May I" status instead of "Full Orders" because he didn't have a single intubation on the year, but because the reporting forms show a bunch of "missed" intubations, he was dropped down.
I completely agree with you, Medic 3. I had a positive tube, all my little doo-dads showed positive, I saw it go through the cords, positive lung sounds with re-checks every 3-5 minutes due to poor road conditions. We get to the ER, and I watch as they (roughly) pick up the patient and nearly drop him back onto the gurney, then they grab the tube tamer I used and switched it out, then put him on the ventillator, took X-rays, THEN and only then did they check lung sounds and lo and behold, it was right mainstem. Did they get screwed for not reassessing, no. I got dinged because I had a bad tube.
Unfortunately it seems as if there are only "bad" medics in the profession. No one, sometimes not even our own services, recognizes "good" medics. All you ever hear about is how a medic "didn't provide quality care" or "gave the wrong medication" or "didn't treat a patient well". Even Medics who did the right thing by breaking protocol because their patient didn't fit into a neat little set of rules gets railroaded because they, in the opinion of those around them, "did the wrong thing." no matter the outcome.
And yes, with multiple patients, we are nothing but a "Cabulance".
Thanks for writing. Your comments were awesome!
Have fun and Be safe
~M. Trommashere~
You are correct. Incompetent or "bad" medics are just asked to go back through non hands' on classes, or put back to something we at home called 'Mother-May-I?' status where we'd have to call our command doc to do anything other than BLS skills. Neither one of those solves the problem though. How is it going to change how I do my IV/Intubation/whatever ALS skill I want to do? Sure, I'll be using my ALS powers responsibly because I have a doctor telling me when and when not to do something, but it's not going to change the mechanics. The doctor isn't there to hold my hand and show me what I'm doing wrong to facilitate a good intubation.
Back home they also looked at the use of an "alternate" airway as a failed intubation. Per our protocols, unless you use CPAP, the other airways are considered a last ditch effort. On the computerized trip sheets, the only way you can show that you used something other than intubation is if you state that you had an unsuccessful intubation. I know of a medic who actually got dropped back to "Mother May I" status instead of "Full Orders" because he didn't have a single intubation on the year, but because the reporting forms show a bunch of "missed" intubations, he was dropped down.
I completely agree with you, Medic 3. I had a positive tube, all my little doo-dads showed positive, I saw it go through the cords, positive lung sounds with re-checks every 3-5 minutes due to poor road conditions. We get to the ER, and I watch as they (roughly) pick up the patient and nearly drop him back onto the gurney, then they grab the tube tamer I used and switched it out, then put him on the ventillator, took X-rays, THEN and only then did they check lung sounds and lo and behold, it was right mainstem. Did they get screwed for not reassessing, no. I got dinged because I had a bad tube.
Unfortunately it seems as if there are only "bad" medics in the profession. No one, sometimes not even our own services, recognizes "good" medics. All you ever hear about is how a medic "didn't provide quality care" or "gave the wrong medication" or "didn't treat a patient well". Even Medics who did the right thing by breaking protocol because their patient didn't fit into a neat little set of rules gets railroaded because they, in the opinion of those around them, "did the wrong thing." no matter the outcome.
And yes, with multiple patients, we are nothing but a "Cabulance".
Thanks for writing. Your comments were awesome!
Have fun and Be safe
~M. Trommashere~
Sunday, July 4, 2010
Outrage
I saw this, and I just had to comment on it. Read EMS1.com and their article on the Mass. EMT's who are upset that they got suspended.
Kim is a state emergency technician. She's been suspended for nine months for allegedly falsifying certification class attendance. She says if she broke the law, she should be punished. "But a nine-month suspension? I've lost my job and my health insurance. I don't now what I am going to do," said Kim
Are you serious?!
You should've thought about that BEFORE you lied about your recerts and possibly paid off someone to get the job done! You should've thought about that when you put patients' lives in jeopardy by not taking your recert classes. What would've happened if in your recert class, they stated that Atropine is now seen to work better if given in a 3mg dose over ten minutes, versus 1mg over 3-5 minutes. Now you go ahead and kill someone because you have no clue what you're doing. What would you say for yourself? Oh wait, you already did that for me!
Quote: She said the harsh punishment of EMTs is unfair, especially because she believes the refresher courses they're required to take have no bearing on competence and knowledge.
"The refresher course just repeats everything. We didn't put you at harm," Kim said.
You don't know if it's "all the same stuff."! Then, a part time Paramedic, who should be watching his ass even closer came in with:
Quote: Terry Urekew is a part-time paramedic who was not on the penalty list, but she believes the state has done an injustice to her colleagues.
"So if it's fraud, slap them. Give everyone a $100 fine and community service," said Urekew. "Don't take someone's livelihood away from something that has no impact on whether or not we are better EMTs," she said.
This moron is why they want to take tubes away from us! Refresher Classes don't have an impact on whether or not you're a better EMT?! I'm guessing the Queen of England came to you and while using the Gilded #4 Macintosh Blade, knighted you and made you God! You must know everything about EMS. Yes, CPR involves you pushing on someones' chest and breathing for them, but without your refresher, you wouldn't know that the compression rate changed from 15:2 to 30:2! Without your ALS refresher, you wouldn't know the new drug dosages, or if the drug had a new delivery system or not.
Both of you, Terry and Kim, need to be ashamed of yourselves! You call yourselves professionals! You call yourselves devoted to your craft, and what do you go and do? You screw the pooch so bad its' still squeeling! Did you not stop and think about what your actions could do and would do? Then you try and say that the heads of your EMS system are forcing your co-workers to work longer hours. No, YOU are the one who has forced them to do it!
"Do you want me working on your mother who is having a heart attack in hour 87 of my 90 hour week?" said Urekew. "Do you want that? That's what you are going to get. There are not enough people to fill the gaps," she said.
I'd rather you be doing it that way because you've worked your balls off all week, attended your correct classes, and had to do it this way, not well rested but as dumb as a box of fly shit.
If it were up to me, all 200 of you would be fired. Not suspended, fired! You both deserve to lose your jobs and your certs and never be allowed to play EMT/Paramedic anywhere in the world again. They should fire the whole lot of you. Doctors who forge paperwork lose their licenses, the same should happen to you.
If the whole system ends up changing for the worst, boys and girls, you know exactly who to thank.
Kim is a state emergency technician. She's been suspended for nine months for allegedly falsifying certification class attendance. She says if she broke the law, she should be punished. "But a nine-month suspension? I've lost my job and my health insurance. I don't now what I am going to do," said Kim
Are you serious?!
You should've thought about that BEFORE you lied about your recerts and possibly paid off someone to get the job done! You should've thought about that when you put patients' lives in jeopardy by not taking your recert classes. What would've happened if in your recert class, they stated that Atropine is now seen to work better if given in a 3mg dose over ten minutes, versus 1mg over 3-5 minutes. Now you go ahead and kill someone because you have no clue what you're doing. What would you say for yourself? Oh wait, you already did that for me!
Quote: She said the harsh punishment of EMTs is unfair, especially because she believes the refresher courses they're required to take have no bearing on competence and knowledge.
"The refresher course just repeats everything. We didn't put you at harm," Kim said.
You don't know if it's "all the same stuff."! Then, a part time Paramedic, who should be watching his ass even closer came in with:
Quote: Terry Urekew is a part-time paramedic who was not on the penalty list, but she believes the state has done an injustice to her colleagues.
"So if it's fraud, slap them. Give everyone a $100 fine and community service," said Urekew. "Don't take someone's livelihood away from something that has no impact on whether or not we are better EMTs," she said.
This moron is why they want to take tubes away from us! Refresher Classes don't have an impact on whether or not you're a better EMT?! I'm guessing the Queen of England came to you and while using the Gilded #4 Macintosh Blade, knighted you and made you God! You must know everything about EMS. Yes, CPR involves you pushing on someones' chest and breathing for them, but without your refresher, you wouldn't know that the compression rate changed from 15:2 to 30:2! Without your ALS refresher, you wouldn't know the new drug dosages, or if the drug had a new delivery system or not.
Both of you, Terry and Kim, need to be ashamed of yourselves! You call yourselves professionals! You call yourselves devoted to your craft, and what do you go and do? You screw the pooch so bad its' still squeeling! Did you not stop and think about what your actions could do and would do? Then you try and say that the heads of your EMS system are forcing your co-workers to work longer hours. No, YOU are the one who has forced them to do it!
"Do you want me working on your mother who is having a heart attack in hour 87 of my 90 hour week?" said Urekew. "Do you want that? That's what you are going to get. There are not enough people to fill the gaps," she said.
I'd rather you be doing it that way because you've worked your balls off all week, attended your correct classes, and had to do it this way, not well rested but as dumb as a box of fly shit.
If it were up to me, all 200 of you would be fired. Not suspended, fired! You both deserve to lose your jobs and your certs and never be allowed to play EMT/Paramedic anywhere in the world again. They should fire the whole lot of you. Doctors who forge paperwork lose their licenses, the same should happen to you.
If the whole system ends up changing for the worst, boys and girls, you know exactly who to thank.
Saturday, July 3, 2010
Reply to comments!
Lizzie: Parents do that, that's why you see more and more kiddie shoes with velcro ties instead of laces. The bigwigs will never get the clue because we as a profession don't stand up for ourselves. In the grand scheme of things, we're the kid wearing the suspenders and the pocket protector trying to try out for the All-Star football team (or Futbol for those over the pond)
New EMT's and Medics feel that they don't have to try. Things are constantly being dumbed down for us. Take the advent of the new airway adjuncts; the LMA, King LT, Combi-Tube, and so on. Their marketing ploy: "So easy a trained monkey can do it." Everything is being made idiot proof. The standard is being lowered to meet the needs of people who shouldn't have been allowed to pass medic class in the first place.
Why can't we as a profession stand up for ourselves and raise the bar. We need to quit allowing ourselves to be "dumbed down." Doctors and Nurses fight like hell the minute one of their skills are taken away no matter how little they use it. When we went through our trial separation from the ET tubes, I remember sitting in the meeting with other members of other services and my own. Everyone groaned and complained about it, but the minute they whipped out the new, shiny toys (Combi-Tubes and the King LT's) everyone was okay with it!
The premise of those adjuncts promotes irresponsibility in managing the advanced airway as well. "Oh, it's okay if you jam this tube in the esophagus, you'll still put air in their stomache and bloat it up, but this ballon here will keep them from throwing up..." We were taught that putting any tube in the esophagus outside of a gastic tube was a bad thing, now you're telling me it's okay to do that?
It's a never ending cycle, but until we stand up for ourselves, we'll just have to keep taking the hits against us.
New EMT's and Medics feel that they don't have to try. Things are constantly being dumbed down for us. Take the advent of the new airway adjuncts; the LMA, King LT, Combi-Tube, and so on. Their marketing ploy: "So easy a trained monkey can do it." Everything is being made idiot proof. The standard is being lowered to meet the needs of people who shouldn't have been allowed to pass medic class in the first place.
Why can't we as a profession stand up for ourselves and raise the bar. We need to quit allowing ourselves to be "dumbed down." Doctors and Nurses fight like hell the minute one of their skills are taken away no matter how little they use it. When we went through our trial separation from the ET tubes, I remember sitting in the meeting with other members of other services and my own. Everyone groaned and complained about it, but the minute they whipped out the new, shiny toys (Combi-Tubes and the King LT's) everyone was okay with it!
The premise of those adjuncts promotes irresponsibility in managing the advanced airway as well. "Oh, it's okay if you jam this tube in the esophagus, you'll still put air in their stomache and bloat it up, but this ballon here will keep them from throwing up..." We were taught that putting any tube in the esophagus outside of a gastic tube was a bad thing, now you're telling me it's okay to do that?
It's a never ending cycle, but until we stand up for ourselves, we'll just have to keep taking the hits against us.
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