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Booze in the Nose.

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of “alcohol on her breath”. I’ve started a lot of charts like this. Seen PD run reports that said the same. I’ve seen it testified to in court….  And it is pretty interesting, in part because you can’t smell alcohol. Sure, you can smell booze–the other crap in the alcoholic beverage. But nope, you can’t smell “alcohol” on someones breath.

 

Smell of alcohol on the breath. There is a very poor correlation between the strength of the smell of alcohol on the breath and the BAC. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath.

 

This is hammered on by DUI lawyers, with mixed results:

“I Smelled a Strong Odor of Alcohol on the Suspect’s Breath”

Posted by Lawrence Taylor on June 23rd, 2006

You will never see a DUI case where the officer does not report an odor of alcohol on the suspect’s breath. Never. The officer expects to smell it and it is a psychological fact that we see, hear and smell what we expect to see, hear and smell. In fact, most police DUI reports are formatted for the usual symptoms: there will be a box for “odor of alcohol”, which the officer checks off. There are often three boxes, labelled “strong”, “moderate” and “weak”; there is no box for “none”, so that is not an option for the officer.  The ”strong” box is almost always checked.  Presumably, the stronger the odor of alcohol, the more intoxicated the person arrested.

There is only one problem with this:  alcohol in a beverage has no odor.

Assuming the officer actually does smell an odor on the breath, what he is smelling is not ethyl alcohol but the flavoring in the beverage. And the flavoring can be deceptive as to the strength or amount consumed. Beer and wine, for example, are the least intoxicating drinks but will cause the strongest odor. A much stronger drink, such as scotch, will have a weaker odor. And vodka leaves virtually no odor at all.

Consider a simple experiment. Have a friend drink a can of “near beer” — the stuff that looks, smells and tastes like beer but has no alcohol in it. Then smell his breath. You will smell an “odor of alcohol” — and maybe a strong one.

And, of course, there can be any number of causes of an “odor of alcohol” on a person’s breath: mouth wash, throat spray, cough syrup. Illness, indigestion or simple bad breath has been the cause of more than one officer’s trigger-quick conclusion that the suspect has an “odor of alcohol on his breath”.

The point of all this is that the odor of alcohol has very little relevence in a drunk driving case. It may or may not indicate that the person has consumed alcohol. It has absolutely no evidentiary value on the much more important question of how much the person has consumed — orwhat he had to drink, or when. Depending upon circumstances, a person with a single drink can have a “strong odor of alcohol on his breath”, and an extremely inebriated person can have a “weak” odor. And an experienced and honest DUI officer will readily admit this….if he is ever asked.

Unfortunately, evidence of the odor of alcohol on a person�s breath can have a significant impact on a DUI case. This is because most officers who pull a driver over for some driving irregularity at night are looking for further signs of drunk driving. When the officer approaches the driver’s window and smells alcohol, that confirms his suspicions. Since few can pass the “field sobriety tests”, particularly under the conditons in which they are given, an arrest is likely.

Are there any scientific studies to back up my claim that breath alcohol odor is largely irrelevant yet disproportionately weighted as “evidence” of intoxication?

In 1999, the same scientists whose federally-contracted studies became the basis of the so-called “standardized” battery of field sobriety tests conducted another study on the effectiveness of alcohol odor in detecting intoxication. These researchers used 20 experienced officers working with 14 subjects who were tested at blood-alcohol concentrations (BACs) ranging from zero to .13 percent. Over a four-hour period, the officers smelled the subject’s breath odor under optimal conditions, with the subjects hidden from view.

The conclusions of the study: Odor strength estimates were unrelated to BAC levels. In fact, estimates of BAC levels failed to rise above random guesses. Further, officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. According to the scientists, these results demonstrate that even under the best of conditions, breath odor detection is unreliable. Moscowittz, Burns & Furgeson, “Police Officers’ Detection of Breath Odors from Alcohol Ingestion”, 31(3) Accident Analysis and Prevention 175 (May 1999).

 

So the moral of the story is that we need to examine how we chart suspected intoxicated patients. Being highly suspicious of all medical conditions that could cause these symptoms is important too:

http://www.monkeydoit.com/medical-act-drunk.php

DIABETES
Symptoms of diabetes may make a person appear drunk or intoxicated.
A person with diabetes may exhibit abnormal behavior as a result of the many different signs or symptoms associated with the disease. The signs and symptoms listed here only relate to symptoms that mimic drunk or intoxicated behavior. Generally, these are warning signs that a person needs immediate medical attention and should be treated as a medical emergency. Police dealing with suspects often times mistake diabetes for drug or alcohol use during field sobriety exercises. 

Signs & Symptoms of Diabetes
-- The smell of acetone on the person's breath
-- A distinctive fruity odor on the breath (Police Officers often mistake the smell as alcohol during a field sobriety tests)
-- Dizzy, has trouble keeping balance
-- Altered states of consciousness
-- Arousal such as hostility or mania
-- Apprehensive with no obvious reason
-- Unusual nervousness
-- Disoriented in place or time
-- Confused when asked simple questions or confused in general about circumstances
-- Sweaty with clammy perspiration
-- Inability to concentrate on what you are telling them or on the tasks at hand
-- Sudden mood changes
EPILEPSY
Epileptic seizures generally happen without warning for most people. A seizure is a brain disorder of abnormal electrical activity in the brain. Seizures may be either partial or generalized and will present signs and symptoms that very among individuals. 
Signs & Symptoms of Epilepsy
-- May appear detached from reality
-- The person might be in a dreamy state 
-- Dizzy, unable to maintain balance
-- Falls down
-- Staring spells
-- Unresponsive
-- Walks away during a conversation
-- The person may have pupillary dilation
-- Sweating
-- Problems speaking
-- They may display an inability to answer questions
-- Contorted posture / limbs appear twisted
-- Flushing
-- Memory and time distortion (they may not remember what just happened)
-- May appear unrealistically fearful
-- May exhibit emotional signs of heightened pleasure
-- May exhibit emotional signs of displeasure
-- May appear aggressive or angry
-- Complete loss of consciousness
BRAIN INJURY
Brain injures will generally have signs and symptoms that relate directly to what part of the brain was injured. Here are just a few symptoms that someone could easily mistake as the person being drunk or intoxicated. These will vary among individuals and to what extent the brain was injured.

Signs & Symptoms of Brain Injury
-- The person may exhibit tremors
-- Dizzy, unable to maintain balance
-- Unable to make simple movements of various body parts
-- Inability to perform a sequence of complex movements
-- Unable to focus on tasks
-- Sudden mood changes
-- Inability to focus attention visually
-- Difficulties with hand and eye coordination
-- The person may suffer from hallucinations or visual illusions
-- They may have difficulty in understanding spoken words
-- They may show signs of aggressive behavior
-- The person may slur their speech 
Brain Picture -EpilepsyALZHEIMER'S
Alzheimer's or dementia is unique for every individual. Alzheimer’s is a progressive and fatal brain disease and the most common form of dementia. The signs and symptoms like the other medical conditions listed here may mimic impairment or drunkenness.

Signs & Symptoms of Alzheimer's
-- The person may show signs of paranoia
-- There may be drastic changes in mood
-- Confusion is quite common with people suffering from Alzheimers or dementia
-- They may have problems speaking
-- The person may exhibit aggressive behavior
-- It's common that there will be problems with remembering things

Repeating myself….

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Only because I think I said it right the first time.

<strong>WE’VE ALL BEEN THERE….

Sad as it may be, many medics spend a great deal of time trying to get out of doing their jobs. We’ve all been there: annoyed, over tired, and over worked. We don’t get paid any more to transport, so sometimes we seem to think that maybe the patient doesn’t really need an ambulance….

I can see how it plaid out in my head. I really can… and that is what scares me the most. In 2008, 39 year old Edward Givens died shortly after EMS saw him at his home. The medic that day told Mr Givens he was just having acid reflux and recommended Pepto Bismol. Two hours later Mr Givens was dead.

You can see it now, can’t you? Maybe the patient is being overly dramatic, or maybe it is the family. You’ve been working for 20 hours and this is your 30th call. You’re 8 charts deep and know that another refusal or no ambulance needed is less work than the transport…

But here is the problem…. it is our job to transport people to the hospital. It isn’t our job to determine whether they need an ambulance or not. If someone wants to go, we take them. Regardless of whether you think they are sick or not. We don’t diagnose. We don’t cure. We are in the business of transporting patients.

I don’t know what really happened that day in 2008, but I do know that we’ve all been there before. We’ve all spent a considerable amount of energy on not transporting someone. Maybe you’ve even had a close call. A stroke you thought was a diabetic… or an AMI that you thought had reflux… But until now you’ve skated by.

Well stop. Stop expending so much energy trying to get out of doing your job. If you’re no longer interested in transporting patients, find a new line of work. When it comes down to it, is it worth risking someones life, your job, and your family’s livelihood on it? The medics in question here were not found to have violated any policies or procedures by their employer…. but do YOU want to live with that on your shoulders?

What do you think about it now?

Night Shift Blues

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For the past 11 weeks I’ve been back on nights. I’ve spent 50% of the last 3 months away from my family, missing them more than I can describe. The hardest part has been saying “goodnight” to my son over the phone. When we started, it was particularly hard. He didn’t really get it, and mostly just ignored the voice on the phone. Now he gets it… and maybe it is even harder… His sad little voice is just too much sometimes.

But in a week, I get to go back to days. There are a lot of changes with that switch to days, all of which make me anxious… But I get to go back to days! I get to tuck my boy in, sleep in a bed next to my wife, and see them both in the morning.

The stress working nights has put on my family is hard to explain… but god damn it will be nice to be home like a normal dad. Three years ago when I started this career I couldn’t imagine how it could put strains on my life….

Be safe out there, friends…

Godspeed,
m3

Applied…

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For a flight medic job. Might be grossly underqualified but the position has been open for a while… thought what the heck!

Wish me luck!

Uninspired.

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For months I have struggled to keep this blog alive. I have posts inside me. I have posts started. I just can’t muster them out. This is really the way a big chunk of my life is going. I am incredibly happy with my wife and son, but something is amiss.

I am often distracted, barely able to pay attention to the simplest of things. Medically, I am an undiagnosed ball of annoying symptoms–not debilitating but the sum of them is wearing me–and my family–out.  I stugle to be the man I promised my wife I would be, while being a father I respect and a paramedic I would trust.

That is all I want–to be a good husband, father, and paramedic. Just like the subtitle to my blog. That is me. There is little more to me than those three things. Sure, I am a son, a brother, a friend. But the sum of these three things defines the man I am today.  Yet I find myself uninspired. I have an amazing wife, an adorable 1 year old son and a job I love doing and I am just uninspired. When I get home, I kiss my wife, hug my son, and go to bed. I fail miserably at sleeping all day and then repeat the cycle.

I make goals–to work out, eat better, spend wiser, study harder–yet I never follow through with any of them. I set these goals again and again and I always end up where I started. Uninspired.

I have the desire to move past all of this, but I just need the right push? What will that push be?

Being an EMS Dad

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I’ve been a paramedic for about 19 months. Not very long, really. My first year was spent working for two teeny tiny services with teeny tiny call volumes. The last seven months with a service that runs right around 10,000 calls a year with 3 trucks covering. Needless to say, I have experienced a lot more in the last 7 months than I did in the year prior to this.

I have been a father for just under a year. 11 months and 7 days, to be exact. As a father I know I will be learning what to do for the rest of my life. My son is amazing and if I didn’t have the amazing wife that I do–well, there isn’t a shot in hell I could do this on my own.

What I didn’t expect was for the lessons EMS would teach me about being a father. The skills I’ve learned since becoming a father are less about medical procedure and more about communication, lessons, and reality.

Reality is the hardest part. Shit happens. Inevitably Asher will get hurt. Inevitably Asher will get sick. Inevitably Asher will make us mad, and I’ll be forced to discipline him. Some how, working in EMS has taught me some skills to be better prepared(or so I am hoping!).

The most surprising skill tune up I’ve gotten while working on the streets came in the form of communication. My communication skills suck. I bottle things up, take them out on those I love, and then don’t understand when they get mad about it. I can be hot tempered, ill mannered, and down right inappropriate. Dealing with frustrating, rude, and down right worthless patients over the last 19 months has taught me that sometimes despite what you think and feel about someone, you have to be able to do your job with self restraint.

Self Restraint. Compassion. Patience. Even now when Asher is so young and innocent, these qualities are getting more fine tuned. After a long night at work, coming home to a screaming baby isn’t easy. Then again, Mrs. MedicThree was home alone with him all night–I don’t imagine me coming home and ignoring them helps her get out the door much either. Before being a medic, father, and husband it was all about me. Now, it rarely is.

Being a medic has taught me how to diffuse situations that could otherwise end badly. Calming a psych patient down, giving stern advice to someone abusing the system, and making sure I am doing so within the bounds of being a Paramedic–and not a judge–is more than a challenge at times. When I first started doing this, I would jump down someones throat for “wasting my time”. Now I understand that sometimes it is easier and better to spend a minute or two trying to figure out(and make the patient) what the hell is going on.

When it comes to life at home, it is more logical to take a breath and treat my family with the respect they deserve. Does this mean I am always cool and calm? Nope. I get stressed. But I like to think that when big things come up I can handle myself–this is something that prior to EMS I’m not sure I could do.

The most unexpected part about being an EMS dad is how being a dad has changed being a medic. Pediatric calls give me a different chill I couldn’t imagine pre-fatherhood. The way I communicate with patients and families has evolved greatly since being married and becoming a father. I spend a little more time trying to make my patients feel better than I did before–most of the time this is done by talking. Sometimes I am a little stern–call it honest–but sometimes that is exactly what the patient needs, and sometimes it is what they want.

Trying to pick and choose the parts of EMS I bring home to my family is the hardest part. Learning how to cope with the realities of my job and the challenges of being a husband and father will continue to be the hardest thing I encounter on a daily basis–but I’m excited for the challenge.

In this line of work it is easy to try and separate your personal and professional lives completely–but it is impossible to succeed. Finding a way to allow them to compliment each other is the key to survival.

New Diggs

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Welcome to my new (and hopefully last!) home for medicTHREE.com! I’m sure you see a few changes(ads, banners, fireemsblogs.com stuff), and you might be wondering what happened. Well, I jumped on the train of awesome(not me…) bloggers who have joined fireemsblogs.com’s blogger community. A project of Jems.com, this community is a new concept in fire/ems blogs.

It is an outstanding idea that really ties together a set of blogs that are focusing on the same topics. Without rambling to much, I’d just like to say thanks to my readers and thanks to the fine folks at FireEMSBlogs.com for bringing me on! Check out the features, the other blogs, and let me know what you think. I’m in the middle of a real post!

Godspeed, Friends!

Change

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I’ve enjoyed my time here on Blogger for the last year and a half, but like many things, it has come to an end. No! No, I am not closing shop, but shop is Moving! I am moving medicthree.com over to the FireEmsBlogs.com Community. I feel honored to be given this opportunity, considering the bloggers that are there already.

First, redirect your blogroll and bookmarks to www.medicthree.com (if you are using the old dailydo.blogspot.com address). Second, head over to www.fireemsblogs.com to check out the bloggers that are there. I’m sure you’ll know most of them.

What this means: My blog will certainly benefit from more traffic. You all will see advertisements that I haven’t ran to this point. There is a leaderboard ad and another placed somewhere in the sidebar. No, I’m not getting rich! It will be hosted on wordpress and that allows much more control and features for all of us. You will notice “community wide tags” were you can click a tag and get all of the posts with that tag throughout the fireemsblogs.com community.

Hopefully within the next 24 hours the blog will up and running. Those of you coming here at www.medicthree.com will notice no difference. Please check out the other blogs there and spread the word. Thanks!

New Blog/theme/bleh

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As you can see I’ve changed things up here. I’ve also started another blog(cause I am already so good at posting here…) about my obsession with bbq’ing! Check it out at www.bbqguyblog.com and let me know what you think. I am still trying to sort out the theme for BBQ Guy Blog, so I’d love some ideas there, too. I’m guess I’ll end up with a “magazine” style.

Let me know what you think of the theme here, please. I’ll get the blogroll back up in a bit!

New Page Elemenets

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Hi friends. As usual, I’ve been dinking around with the site and would like your opinion of a few things:

The friend connect bar on the top(you can join my site as a follower and also comment on the site as a whole or share things with my readers)

The “share this” button on each tag.

There is also “tweetboard” installed, but it doesn’t seem to be working properly. I may just nix it if someone from tweetboard doesnt’ step up to help me fix it. It was working fine but as some of you know, I got rid of the @courtesyshock username at twitter.com and now can be followed at @medicTHREE

Let me know what you all think. If you enjoy my blog consider following it(plus this gives you an easy place to bookmark sites you follow). Also please share posts through the “share this” button on each post if you like them! Linky love is always much appreaciated!

PSYCHIC PARTNER

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“If shit doesn’t change around here he is going to lose all of his best medics”

me. “Yup. I hear ya”

Inside my head…. “it is already too late”

Um… Yeah….

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So, It has been rather apparent that I can’t make my mind up. At all.

In the past 6 months I have:

  • Abandoned MedicThree.com
  • Started and abandoned glutenfreedad.com(no longer hosted)
  • Started and flopped on courtesyshock.com(still up)
  • Started, but done nothing with medicdad.com
  • And now I am back with medicthree.com. Format might be a little different, as you can see, but back I am. I have new motivation for some posts, and my fears of exposure are all but gone. A few people
    here know me in real life. One of them is one of my supervisors–but, if I can’t trust her… I’m in a world of hurt anyways!

Anyways… I assure you that by the end of the night there will be an ACTUAL POST HERE…

So… Let me know how things are going! What do you think?!?!?

"It Can't Hurt" Medicine

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EMS is essentially an art form. Unlike clinic or hospital based medicine—even medicine practiced in the Emergency room—EMS is a balancing act. We go into a call with a few tools:

  • Protocols–Whether you see this as an advantage or a hinderance, they are here to stay. Protocols allow EMS providers to fall back on guidelines to help them during difficult and challenging patients. They also allow providers to hide behind a shield when they do something for no other reason than “my protocol said so”.
  • Assessment skills–Some medics have them… Some don’t. All of us go to a medic school of some sort. All of us had to pass National Registry. Does this make all medic’s assessment skills equal? Nope. I solve problems. I have a classmate that does less “problem solving” and more pulling the answer from his ass like he is a walking Taber’s Medical Dictionary. Because of the varied assement skills of providers, many protocols are written in a manor that eliminate the need to even assess a patient beyond the ABC’s.
  • Diagnostic tools–From a stethescope to pulse oximetry, capnography, and cardiac monitors–these diagnostic tools can help you to obtain a more clear image of the present problem–they will not diagnose a problem though.
These things together are the basis of our profession. They allow us to do what we do, day in and day out.  Without any one of them, we would, in all reality, be out of business. Sure, we need to be able to make due without pulse ox or capnography, but without a defirilator I am unable to convert V-fib, without my drug box there are a great deal of things I just can’t do. Without my protocols I won’t have the authorization to do what I do. Without my assessment skills I won’t know when and where to use any of the above.

That is all true–unless we practice lowest common denominator(to quote RM), “It can’t hurt” medicine. “It can’t hurt” medicine refers to oxygen for no specific symptom, drugs down to tube in an arrest, etc. Just because we don’t have “proof” that something causes harm, doesn’t mean it helps.

Our job is simple. We are called to help in our patient’s emergency–whether we percieve it as one or not. We are to treat each patient as though their emergency is the most important thing going on–at that time. We are to spend the time needed to determine what THAT patient needs, and give it to them.

Now, some might say we can’t afford this time–but lets be honest. How much time does it take to decide if someone NEEDS oxygen. It is usually rather apparent.

How about if someone NEEDS nitro or ASA? Not all chest pain is created equal. If we are afraid to train our medics to differentiate between cardiac and muscular-skeletal pain we might as well throw new Basics on the truck and skip the training for medics. It would save EMS systems around the country loads of money(though depressingly not enough!)

When did we decide that paramedics where no longer qualified to assess and THEN treat patients. When did we decide that just because we haven’t been told that something could HURT our patient, it is ok to do every time (oxygen, drugs, spinal immobilization, prophylactic IV therapy, etc)?

When will we bring assessment back into EMS? What would YOU do? What freedoms and
limitations does your system place on the providers it employs?

Dr Bryan Bledsoe has a great article out right now about “The Oxygen Myth“. It dicusses the issue
with using oxygen on EVERY patient, rather than patients that actually need it.

Check it out and let me know how you feel.

Still Alive, Barely kicking…

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Sorry I haven’t graced your web browsers/RSS readers in a few weeks… Been spending the last few weeks adapting to the unknown!

Asher is doing great. He finally figured out how to cry. He is great at it. My mother says that he has a temper like me… Fine, fine, fine, PISSED. Fine, fine, fine, PISSED.  Usually involving food, just like daddy.
We spent the first night in our new house in my home town last night. It was the most relaxing night I have ever had. We started the move about a week and a half ago and as such, have been staying with my parents for the last week. I am eternally greatful to them for putting up with us, but it just isn’t the same as being in your own home.
Right now we only have 2 of the 3 dogs with us. The lab has been at the in-laws since Asher was born and I can’t wait to get him(bleeding tail and all) back here with us. 
I don’t have a lot of great posts built up…. but I do have a few in the works that I hope to work on over the next day or so. 
Godspeed,
M3

Moving Time!

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Found a 4 bedroom, 3 bathroom house in my hometown. Signed the lease this weekend, move March 1. Here is the catch… The color is similar to this…

Cool on that Truck. Not so cool on my house. My co-workers are already having a field day with this!
The New blog is over HERE: www.glutenfreedad.net

Despite Common Belief…

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The end of the world is NOT near. I frequent blogs of every size, shape, and color–many of them as politically different from I as bears from lizards. I love all of these blogs–otherwise I wouldn’t frequent them! Having spent a few years of my life as a cog in the political machine known as Campaigning I have insights some might not appreciate. I do NOT know everythiing–but I’ve seen a few things that most haven’t a clue about.

Rest assured my friends–The world is not coming to a screaching halt. Life will go on. Things will change–but that is the nature of the world that we live in. 4 months ago our economy was merely “unstable”… Today it is plain old shitty. A year ago Iraq was the primary concern amongst voters… Today it only ranks number 1 with only 10% of votoers–Sad, but true.
Our next President(no matter who it should have been) is going to be presented a set of battles that few stand ready to fight on their own. Despite campaign retoric about who is best suited to be President I am a firm believer that NOTHING PREPARES YOU TO BE PRESIDENT OF THE UNITED STATES OF AMERICA. 
Being a Senator, Mayor, Congressman, War Hero, Draft Dodger, Football Player, or US Army General does NOT prepare you to be President of the United States.
As POTUS all men are created equal. All men face the challenge. I’ve heard so many comments already that our National Debt will now triple because of Obama, and that our National Security will now falter because of Obama. If this is so much the case, you have solidified that everything that has went wrong in the last 8 years is the fault of George Bush. Is that the case? I doubt it. If you are going to blame every failure of the next 4 years on Obama(and there will be failures–and triumphs) then remember that the previous 8 shall be blamed on GWB, and the years to follow Obama shall be blamed on whoever dares follow–even if it is YOUR guy.
I have some news for you, my friends. Our National Debt is going to continue to spiral out of control, no matter who takes office in January of 2009. As a matter of fact, GWB isn’t even to blame for the beginning of that double helix of debt and despare. An inflated US economy based on an inflated US dollar are to blame. We are fighting 2 wars(technically 3) all while lowering taxes–a proven method to increase National Debt(now did Bush manage to magically pass tax cuts without the help of the United States Congress?). 
The National Debt has reached a level that the specifics are no longer relevant. The difference between 2 and 3 Trillion is so trivial that only economists can comprehend the difference between my grandchildren and great grandchildren paying it off. The state of this Economy will NOT allow Obama(or anyone) to go into gigantic spending binges–no more so that we are already. 
Taxes will rise. The Bush tax cuts near their ceiling. It is TIME WE START PAYING FOR THE DEBTS OF OUR GENERATION. If we want to fight 2 wars, bail out Wall Street, and protect our borders, we NEED TO PAY FOR IT NOW. Never in history were tax cuts put in place at the same time as a costly war. Since when do we get to fight a war now and pay for it later?
Life will go on.
At the end of the day there will be two types of Americans–Those who wish to work together to rebuild, and those who wish to point fingers and blame. 
If the far right wants to take the place of the far left in blaiming the current POTUS for America’s turmoils, so be it–but understand completely–no problem has ever been solved by merely pointing and whining. If you want to fix the problems this country faces you need to stand up, speak your mind, and in turn LISTEN TO YOUR OPPONENTS. This cycle must continue till some common ground is met. 
Life will go on. 
The end is NOT NEAR. 
Stand up America. No matter who would have won today, History would have been made. For once our Country is making progress and this is our chance to sieze it, embrace it, and work together to prove to the world that we are worthy of our status. 
Also… If you can’t remember that we have bigger problems than which talking head pretends to lead this country, take a daily glance at this(as no matter who is POTUS, the story will still sadden my heart):
Godspeed. 
Be safe out there–
MedicThree

Shady, Shifty, Fly-by-night Research.

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Rogue Medic has been working on a series of posts concerning “research” in EMS. His most Recent post Whisky Tango Foxtrot Research relates to my post on spinal clearance in HEMS.  

As usual not only did he get me thinking, but he pushed my dreams of being able to articulate my thoughts as proficiently as he just a little further away!
While he is focusing on the lack of an quality research in EMS, I am more focused soley on the validity of HEMS triage and the reality of safety in HEMS and Ground EMS. However, he did get me thinking with a few of his commets:

There is no good EMS research, if there is no good EMS in the study.

Assessment is the medical skill. Without that, nothing else matters.

Not much reason to believe that spinal clearance patients need to fly.

He couldn’t be more right with that one. So much time is spent in EMS doing Quality Assurance–but how much of that actually focusses on real tangible skills? Instead we focus on numbers–response time, scene time, out of service time, 12-lead scene time, etc, etc, etc. We aren’t assuring that our medics are capable of actually assessing a patient.

As a matter of fact, we are assuring that they don’t even get the chance to assess patients by taking the direction that protocols are to be followed in strict accordance, not as guidelines. Protocols can be a powerful tool. They provide a standard of care for patients with similar presentations. They do NOT assess the patient though. 
A patient with chest pain needs little assessment based on most ALS protocols. IV, O2, Nitro, ASA, Morphine, 12-lead, transport. 
Our “protocols” state any patient with substurnal chest pain, radiating arm pain, non-localized chest pain, un-specified epigastric pain, or a “HIGH LIKELYHOOD FOR CARDIAC ORIGIN” gets a full cardiac workup. While this one actually allows for some sort of assessment, it does not allow us to stop cardiac procedure for non-cardiac chest pain. Not that I do a full cardiac workup for trauma related chest pain–but my protocol says I should.
If I wasn’t the “thinking” type, I’d be putting a lot of patients through procedures that they didn’t need at all, and in some cases could actually be detrimental to their outcome.
The attempts to reach Quality Assurance in EMS are in vain. They lack any substance and many services are prime examples of this–HEMS included.
When a ground service calls for HEMS intervention, the HEMS service should demand a full report. Recently we were called to a high school football game for a 17yo male how spike his head into the ground. We were on standby at another game and the local VFD was on standby at that game. 
We were called out, Code 1 but quickly upgraded to Code 3 when the VFD requested we try to request HEMS. Now in our area we rarely use HEMS. We can usually be at the receiving ED door before HEMS would get them there. Unless the patient needs a skillset that we absolutely cannot preform then there is no reason for us to delay transport. The VFD requesting HEMS got our blood pumping and as my partner drove in ways that make me cry at night, I was trying to hail the VFD over the radio. 
Once I finally got through to them it became clear that the HEMS was more out of emotion than need. When we arrived to find mom and dad calm(dad is a volunteer EMT in a town about 40 miles away) I knew it was an overreaction common to these circumstances. 
How often do we think that Emotion plays a major role in the usage of HEMS over practical assessment and triage? 
Many might wonder why it is that I am ragging on HEMS so bad. So here is where I will end it:
  • HEMS response times often delay the transport of the patient.
  • ALS skills outside of what Ground EMS crews use are rarely utilized in HEMS
  • HEMS is inherantly more dangerous. The use of HEMS should be limited to patients that will benefit from the extended skill set of HEMS providers or from the speed of HEMS(if HEMS is infact faster than ground EMS)
  • HEMS usage inside city limits is rarely beneficial
  • HEMS management by Hospitals could easily be seen as means of providing higher level income. Not only do they get to bill more for a HEMS services, but they will then have a patient that likely requires ICU or other Critical services(where SOME of the money lies(nothing is as profitable as outpatient surgery))
If we aren’t assuring that we have quality providers on the ground interpretting and implementing our protocols and QA directives, what point is there in measuring any sort of QA? 
At what point will we finally realize that we aren’t assessing our own skills–let alone actually assessing our patients?

Spinal Clearance

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Jems.com has an article published yesterday concerning a study relating spinal clearance and HEMS.

The study is entitled “Clinical Clearance of Spinal Immobilization in the Air Medical Environment: A Feasibility Study.” This study was published in the Journal of Trauma and thus I do not have access to the entire data set.

What I do have access to is a knowledge base of common sense.

Honestly, the fact that this is even being considered is moronic at best. If someone is stable enough to be cleared from spinal precautions in flight by HEMS crews, they had no business putting them in the aircraft to start.

Further, doing a spinal clearance exam in the back of a helicopter which is 1/3 the size of an ambulance is completely insane.

I think this study proves how irresponsible we are being with HEMS. We aren’t just wasting money(and a lot of it), we are risking lives. The use of HEMS in many settings is debatable enough in itself, we need not compromise logic altogether in the use of HEMS.

I admit that many flight crews are better medics than I am. I’ll also admit that I’ve met enough flight crews that were mediocre at best and scary or dangerous sometimes, to know that being a flight medic does not mean you are a good medic.

No one ever considered doing this on the ground and there are plenty of ground crews out there with the same or more Critical Care training than flight crews. My Internship was with a service that ran Critical Care trucks that had a Nurse/Medic crew and I promise that they never considered doing a spinal clearance exam in the field.

Be smart out there. Watch your back and do what you KNOW is best for the patient. Sometimes that means bucking the line, and sometimes that means fighting a system hell bent on making the most money possible.

Good Luck, Godspeed, be safe.

Things to come…

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So, as I’ve mentioned, I’ve got some things to come. I have a new domain name, and new blog title–don’t think that means CHEATING DEATH is gone. My intent is to make it so that I have two persona’s on this blogamaboberish. Maybe it’ll work, maybe it won’t. Who know. 

Also, I’m going to try to starting bringing back good news/bad news. It is one of those things that may not happen weekly, as honestly, digging up dirt on EMS is not only time consuming, but depressing. The state of affairs we’re in as a healthcare community pretty much sucks.

Expect a new theme—and very soon. It is going to rock though, I can tell you that!

So, with that, I am going to also spend more time on all of YOUR blogs. I haven’t been spending much time out there lately, so expect a lot more useless comments that will make you… eh, bored still.

I’m also going to spend some more time writing things that don’t come off as jibberish(like this post). That means that while there won’t be days of 234233 posts, there will hopefully be a post each day. That means you best be getting your asses over here more often to read this crap. 

PS, I know which of you are coming to read, and which of you aren’t. I know a few of you little buttfaces use “readers” to enjoy my ramblings. Like newspapers are better on paper, my blog is better with its’ fancy new getup. 

So, give me some love. OH, and expect some other cool stuff to follow too. I’ve got some other things that have gotten the gears moving in my head and hopefully they will spark your interest. 

I’m going to try to get a little closer to how I started out this way. 

Updates continued:

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The new email address to contact me is: MedicThree@gmail.com 

Please send all complaints to THIS email

Ch-ch-ch-ch-changes

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For Starters… I made the plunge and registered a domain name for my blog: WWW.MEDICTHREE.COM  

I haven’t decided, but I expect to change the Title of the blog too. Looking for a new theme that isn’t so…. I don’t know… “full”?