Rogue Medic‘s ranting “New Series of Rants follow up” inspired me a little. BS and bureaucracy did the rest.
In EMS–hell, in ALL of medicine–we are plagued by many diseases. No, I’m not talking about TB, HIV, Hep C. I’m talking about BS and Bureaucracy. I’m talking about what “The Book” says and what real life says. I’m talking about protocols, text books, insurance companies, and lawyers say. I am NOT talking about reality. I am talking about the world where we overcomplicate, over-treat, and under-assess our patients. I am talking about why our healthcare system sucks.
As a Paramedic the glory of my job is supposed to be trauma, blood, guts and gore. It is supposed to be that awesome “save”(we will discuss the diference between a “save” and actually living later), or that super cool gun shot/stabbing/ice pick in the eye with a case of DKA with SVT and a GCS of 4. But for me, it isn’t. The glory of my job is actually treating patients–any patient–and improving their condition.
Now, I am a little more(or much less) fortunate that many of my fellow EMS bloggers. I have no protocols. I am God. I am not a paragod. But I am the end all. If I decide that I want to cardiovert–I do it. I don’t have to call 3 doctors and beg for permission. I don’t have to justify it so I can convince someone. Lets face it. If you are calling to OLMC to ask to do something, you are going to give the signs that should convince them it is ok. You aren’t going to give them the signs you missed that contraindicate your treatment. Even worse–if you call OLMC and don’t have a clue what to do, the Doc is usually going to tell you to get your ass into the ED and don’t kill them. Thats it.
So… We’ve established that I can do whatever I want. This is likely bad. I don’t even have a protocol book to follow for those wierd cases. I have ACLS, AMLS, PHTLS, PALS, PEPP, NRP, and the good ‘ol NREMT for my guidance. Don’t mind that damn near every one of them has a different standard. Look it up: How much blood can be lost in a closed femur fracture? When do we apply tourniquets? The list of discrepencies goes on, and on, and on, and on… So, While I don’t have to beg for permission to do something, I have to decide which set of standards and guidelines I’m going to use. Yippee!
Like the rest of my fellow EMS/Medical bloggers, I am plagued with the other thorns in my ass that they are. I have to make sure every word on my chart is perfect and that I make sure it is CLEAR that it was an emergency–all so that Medicare can underpay my service anyways. I have to get 3 signatures for a PRS. Many places even have a fancy Refusal Flow Chart. As a matter of fact, not only does the patient sign their life away, but I have to sign my life away twice to allow a patient to refuse care. Seriously.
So, we have to sort through a lot of BULL to do our jobs. I have to make sure the patient WANTS our help, I then have to assess the patient and determine how the patient NEEDS our help, and then have to determine WHICH treatment is appropriate. Like a responsible Medic, I start with the obvious. I do a BLS assessment—Airway, Breathing, Circulation. If they don’t have an airway, I give them one(and I’d just assume shove an oral airway or combitube in rather than an ET Tube–do you have any idea how much extra cleaning and paperwork I have to do if I use the ET Kit?!?!?). If they ain’t breathing, I breathe for them(honestly, I usually make a firefighter do it. I AM a MEDIC(all kidding asside, usually a FF is the one doing the bagging… and the compressions)). And if they have no circulation, I thump on their chest(or, as stated before, have a FF do it). If they are bleeding out, I stop it.
Where in those very basic things did it say: Start an IV, Run a 12 lead, intubate, blah, blah blah? An EMT-B can do every one of those things, and that is what every damn medic should be doing. There are plenty of cases where ALS skills are great–but rarely do we save someone in the field with ALS skills that couldn’t have been saved in the hospital with ALS skills.
Sure. Cardiac Arrests. We can push drugs that EMT-B’s can’t. Honestly, I don’t know why. Why is it that a EMT-B can’t flush some EPI down a combitube for someone in Asystole or VF? Why? What are they going to do? Kill them? I think not.
There are times where us giving drugs earlier can HELP the outcome of a patient. Early Nitro, Narcan, glucose for someone with low BS, etc, etc, etc. But MOST of what we do is BLS. I should rephrase that–Most of what we SHOULD do is BLS.
If we were doing BLS most of the time, I bet we could reduce the number of other BS factors that fall into line with our jobs. Speaking of which… I have to write a chart. More to follow tonight or tomorrow morning!
Do any of you have first hand experience of the crazy things meds made you do? We hear stories all the time from patients and coworkers, but I’d like to hear your own stories.
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.
