As usual, the EMS blogosphere has found itself in yet another little tiff. This time Timothy Clemans and Medic22 are in a bit of disagreement about proper use of ALS, among other things.

Timothy seems to believe that ALS skills are wasted on patients that are not in risk of losing life or limb. While Medic22’s way of responding to him might be over the top, I can TOTALLY understand how and why that would happen. See here and here. We all take this pretty damn seriously, so I understand the frustration.

Because I agree with Medic22’s thought process on this, I thought I would chime in a little bit.

If it was up to me I would eliminate prehospital ALS except in cases where ALS care prevents the need for hospital/clinic care and in cases where evidence demonstrates that ALS saves lives. That said, Medic 22 did bring up an excellent point about prehospital pain management.

Is it really that simple? Simply put, I’m out of a job. All of us are. In a system with 11,000 calls a year, we’d be able to pay one medic. Thats it. After the sob story of me being unemployed is over, we’ll address the real issue: why is it that you have to be dying to get compassionate, adequate, respectful care?

If you are sick or injured, but not dying, Timothy is saying that you should only get a taxi ride to the hospital(where you will wait in triage for an hour(or more) and then wait for a nurse to complete an assessment, then a doctor, then maybe get your treatment started).

Are there ALS skills that need to be reviewed? Absolutely, but until you have had to sit in a truck with patients puking their brains out(on your new, shiny boots) you will not understand the validity of our skills that are in between taxi driver and super hero. Pushing Zofran for that nausea not only helped to relieve the discomfort for that patient, it also helped prevent them from further dehydrating themselves (or like a patient a week ago… going into vfib every time she puked… Seriously).

Managing pain in patients is one of the best skill sets we offer(and either the most avoided due to paperwork or most abused by patients).  Allowing grandma some comfort for the 15 mile ride through my Wintry Mid-Western city riddled with potholes and ice chunks is the least I can do after she allowed my whiny ass to stay alive all this time.

I can’t agree more with you! I have been battling this topic for 7 years to no avail. At one point we had our agency MD on board yet the other program MDs in the county voted against it! Again, “nobody ever died of pain” was just one reason. Another was/is the potential abuse issue, especially with fentanyl compounded by the fear ketamine could be stolen off the trucks by youngsters for their Rave parties. Subsequently, our patients receive a proper induction via etomidate but very infrequently the administration of diazepam and morphine post intubation (only a few of us religiously use the agents). What you end up with is a patient who doesn’t remember undergoing paralysis and intubation but wakes up being paralyzed and intubated on a bumpy ride to the hospital.

All this says is that local MDs have zero faith in their medics. If you can’t secure your narcotics, you have no business being in this business. There are dozens of ways to secure them. This is simply an excuse for someone who is afraid to allow their medics the ability to treat.

Medic 22 a dehydrated girl with a low BP and tachycardia needs a line and a fluid blous. That’s ALS. Not an emergency… but something that a paramedic can, and SHOULD do.
Me: what’s the benefit of the prehospital als in that case? if it doesn’t save a life or shorten hospital stay what’s the point
Medic 22: It’s GOOD PATIENT CARE. Its what competent, caring prehospital care providers do.

If the care by paramedics could prevent the need for hospital then I’m all for it. Unfortunately in the case wouldn’t you just be delaying hospital care and doing something just to do it?

First of all, you are assuming we are delaying care. Like I said before:

My scene time consists of a brief primary assessment, possibly a 12 lead and loading the patient where I begin the rest of my treatment–unless the patient absolutely needs other interventions prior to departure. That being said, when I am 15 minutes away from the hospital with someone puking(and further dehydrating themselves) or someone who has moderate wheezes, why shouldn’t I begin treating them?

Again…. It seems that you assume there is some abundance of Life or Limb calls in EMS. Honestly, those exciting calls just don’t come all that much. What we get a lot of is sick baby boomers, indigents, drunks, and people who don’t know any better. Does that mean we shouldn’t treat them while we can?

It is our job to treat patients, and as long as I have time in the back of my truck, I am going to do everything I can to make them more comfortable, happier, and healthier–if at all possible.

I am a stubborn guy. I know when I’m right, and I don’t back down. As a matter of fact, my insistence on being right has alienated more than one person in my life. I just can’t handle people who won’t admit they are wrong.

That being said… When I’m wrong, I admit it. I might not be happy about it–often I beat myself up over simple things. But I admit I’m wrong. In this line of work admitting you are wrong is more important than always being right. Knowing when to ask someone smarter than you is one of the most important things in EMS–hell, all of medicine.

If you can’t admit you are wrong. If you can’t understand that asking for help is a virtue, not a fault… Then maybe this business isn’t for you.

Woman charged in breast milk assault on jailer

OWENSBORO, Ky. — A woman in jail for public intoxication was accused of assaulting a jailer by squirting breast milk at her. WYMT-TV reported that a 31-year-old woman was arrested Thursday on a misdemeanor charge of public intoxication. But as she was changing into an inmate uniform, she squirted breast milk into the face of a female deputy who was with her.

The woman now faces a felony charge of third degree assault on a police officer. Her bond was set at $10,000

wha… tha…. fa….

Sadly this sounds like more than one of my patients this last week.

En Route to a Code 3 “Sick Person” my partner says….

“Oh, this should be good”

Why?

“Dispatched as a sick person, stumbling, falling down. Great. Another Fucking drunk”

Oh. You listen to that crap? After the address and the part about going fast or slow, I quit paying attention. Literally.

• @emtdani just for you http://medicthree.com/2010/02/if-you-are-offending-easily-plus-leave-now/ #
• @Epi_Junky @medic_bella glad I could help. M3, always here to piss people off. And do MY GOD DAMN JOB WITHOUT WANTING FAME AND GLORY! in reply to Epi_Junky #
• @MsParamedic if you don't like my drama dani has a button she can show you….. in reply to MsParamedic #
• @MsParamedic but then I'd have to cut myself #
• How can curling seriously be a sport… #
• Sorry I'm a jackass. I take my job seriously and don't like people who make a mockery of this. This profession is a joke to a lot of people #
• ugh #
• So I think we're going to drop daycare and tough it out at home. SO much for me sleeping in between shifts. #
• ugh….. need to win the lottery. asap. #
• tweetdeck won't let me add a column. wtf #
• fixed. Damn thing hates me. #
• @mariah_ @paramedicdan was a ricky rescue who somehow saved everyone and went on the coolest calls. all by himself. and he violated hipaa. in reply to mariah_ #
• is there a better multi twitter account app that tweetdeck? #
• Trying seesmic. Not sure what I think. #
• I am starting to get sick. Sore throat. Running nose. Congestion. Can't sleep and have a day at home with my little guy. Ugh. #
• @scoolgirl101 had a mt dew? I would like some whiskey, but that seems irresponsible! in reply to scoolgirl101 #
• @scoolgirl101 It wouldn't be bad at all if it wasn't for the throat. I live with congestion year round anyways…. in reply to scoolgirl101 #
• @twnstar2 don't think i care for seesmic for multi account use…. in reply to twnstar2 #
• @twnstar2 i like seesmic on my droid, though I use tweetcaster currently in reply to twnstar2 #
• Follow me on FACEBOOK! http://bit.ly/9ZOKG0 #
• I have been smoke free for 18 months. 1 single slip up. I am damn proud of myself. #
• Really should be sleeping. when the kid gets up in a few hours I will be cursing this… #
• @slichten01 I have temptations every now and then but using chantix made it easy in reply to slichten01 #
• (603): wait can you just look around please? that was my favorite bra and i've already asked like 3 other guys #
• (651): Just wanted to let you know that I always win at "whose ex is crazier" because of you. #
• I love tfln….. #
• @RVaMedic google "tfln" it is "texts from last night" in reply to RVaMedic #
• why will gmail load in firefox, opera, and IE, but NOT chrome? That makes about NO sense… #
• follow me on Facebook! http://bit.ly/9ZOKG0 #
• @Bella_Medic Happy Birthday! #
• wish @bella_medic a HAPPY BIRTHDAY! #
• 69 yo m, pulse 50, bp 80 systolic, syncopal episode. What would you do? #
• The above pt had a negative 12 lead. After 250 ml fluid challenge, pt vomits, pulse drops and stays at 45. #
• .5 mg atropine on board, pt condition improves. Then pt codes as we roll him into the ED. #
• @Monhae ding ding ding! Pt took 2 extra doses of his beta blocker today. Was released 3 hours later. in reply to Monhae #
• had a guy that jumped off a 3rd story parking ramp… A&Ox4, no obvious injuries. Full spinal precautions and trauma team activated… #
• pt had skull fracture and subdural hematoma. #
• Seriously? Hot air ballooning when it is 9 degrees out? Wtf? #
• Have had a week of actual calls. Crazy. trauma. SVT. Actual, real, fun calls. #
• Seriously… How much can she pad her ego? http://bit.ly/aiAQRy This crap is insane. How can she talk to a nurse like that and be proud?? #
• I am asking my followers to block @emtdani I can't handle it anymore. She is an ego padding, narscisistic lier who needs a reality check. #

Part of my continual writers block is overcoming the starting point. I have always been a “title first” kind of writer. I come up with an idea based on some title or thought. From there I work.

Here are some of the Draft Titles sitting in my “posts to be completed” pile:

• The Losing Game
• Turn The Wheel
• Ummmm…..
• Dialogue
• Complacency Killed the Cat… Err… Patient…

Since one of my least favorite bloggers moderates her comments, and mine will never make it public. I have decided to go here. If you need a clue, let me know.

Bullshit. Bullshit. Bullshit.

Does it make you feel better to make shit up or do you have a serious psychological issue?

I am honestly concerned about your health. You have this constant need to feel important. Like YOU matter. YOU do not. None of US do. As a tech in a hospital you do things that are essential to the hospital. But nothing that any other competent tech couldn’t. YOU did not save anyone. YOU are NOT important.

You think you have some magical powers, great looks, awesome personality, and clever wit. Guess what. You don’t. You would only impress someone who has no medical knowledge at all. Even then, they’d have to be a dumb ass to believe you.

Go to bed, get up, and get a damn life. Sweet Mary, Mother of God. I seriously can’t handle all of this crap anymore. You get your rocks off making yourself feel important to the blogosphere.

Take your @paramedicdan-esque ways and pack them up. The only people who pretend to believe you are more fascinated with your whorish ways than anything else.

Quit making EMS look like a joke. We take our jobs damn seriously and we are sick of people making a mockery of it.

• 9 calls in 3 hours. booooooooooooooooooooooooooooooooo #
• yeah. not cool. Now we sit around waiting to take a transplant team to the airport. Blah. #
• Plan on getting an Upper GI scope for shits and giggles. And to get a biopsy for celiac. #
• @Bella_Medic yeah, I am just sick of my stomach problems. SO I am digging for answers. in reply to Bella_Medic #
• @medic61 biopsy is the only definitive dx. Blood tests are unreliable. in reply to medic61 #
• @paramedicintern nope. 4 transports. 3 within 5 blocks of eachother. Not a damn one was significant. in reply to paramedicintern #
• @paramedicintern then I sat around for 6 hours….. in reply to paramedicintern #
• @paramedicintern we can chart as "no ambulance needed" on lots of calls, saves time associated with PRS. in reply to paramedicintern #
• @paramedicintern That seems silly. Often times 3rd parties call 911, why should a "patient" have to sign a PRS if there was no amb needed? in reply to paramedicintern #
• @paramedicintern I believe that the PRS should ONLY be used when you believe they NEED an ambulance. in reply to paramedicintern #
• Can't sleep #
• Why is it that at 3am volume level 1 is loud but at 5pm level 8 is barely audible??? Seriously. #
• RT @autocompleteme Autocomplete Me » Battle Of The Sexes: Autocomplete Style http://bit.ly/6XDmfS #
• @medic61 I can't sleep… but thats because Night hates me… in reply to medic61 #
• RT @setla: RT @zollemsfire: Get a free exhibit pass to EMS Today, with our compliments. http://bit.ly/b90UJw #
• At famous dave's with the family! #
• Was a pt last night and I don't even remember it….. #
• @MadMedic1 I am… got knocked out. Don't even remember seeing ambulance….. in reply to MadMedic1 #
• Just rooted and loaded a rom on my droid, from http://forum.droidmod.org/index.php/topic,73.0.html wicked easy, wifi tether! #
• Asked doc about my jaw, doesn't seem worried. #
• @NJDiveMedic yeah I'm good in reply to NJDiveMedic #
• ugh… my jaw hurts! Doc says it isn't broken and to STFU and do my job… sob. #
• Dear Mrs M3, Happy Birthday, as a present, I give you a bruised and battered M3, free concussion as well. #
• @medic61 ew! Easymac is ewwwwwwwwwtastic! Spirals FTW! in reply to medic61 #
• @medic61 89 cents a box is worth it for quality!!!!!!!!!!! lol…. in reply to medic61 #
• @medic61 I never sleep! Do you use google talk? in reply to medic61 #
• anyone who uses google talk, DM me! #
• First call in four hours. #
• So tired but can't sleep. I am bored awake. #
• Little man is fighting this versed. …. #
• Hope he can get this test done today #
• @Harwetopa I got sucker punched, fell forward onto my head…. #
• @Harwetopa no such luck. I don't remember anything and he ran off. in reply to Harwetopa #
• @JustMyBlog thanks! he is normally sooooo sweet. Today he was a monster. in reply to JustMyBlog #
• @RobRiscoe my dream feels a lot like a broken record…. in reply to RobRiscoe #
• Enjoying my drive home. Putting another long shift to bed. #
• Highway 20 ride…. #
• Finally! Epocrates for android! #

Asher had another VCUG and Lasix renogram today for his hydronephrosis. Won’t have results for a day or two, but it looked like it always did… delayed draining of the left kidney. Hoping they find something diagnostic soon.

Until then, here is a pic of the little monster(who does not like anesthesia… fought it really hard).

After a dose of chloral hydrate and 2 doses of versed… the walk BACK to PEDS is what put him to sleep… Stinker.