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!
Archives for changes
When I should have been sleeping Thursday night, I was watching “I am Sam” on TBS. I actually tried to walk away from it a few times, but I guess I’m a sap for that kind of thing. Well, not really, but whatever. This post IS a little bit rambling and a lot scattered. Mostly because I’m a LOT emotional about it. I’m sick of watching “EMS Professionals” treat patients with complete disregard for the most basic of human needs.
It got me thinking about the countless parenting lessons the Main Character “Sam” offers us. As a mentally handicapped dad with an IQ around 70, the struggles WE all face on a daily basis are compounded–yet somehow he does it better than most parents could imagine. So… Because it is what I do, I TWEETED it. Next @EMS2Foundation asked me a simple question, that made my mind spin out of control.
do you think there’s any good lessons from “I am Sam” for EMS personnel?
Obviously I am Sam is full of Life lessons in general, but I think that the overwhelming theme is about compassion and understanding. I’m not sure what it was about this question that really got me going, but it did. I actually got frustrated trying to write this post–not because I can’t find the words or ideas, but because the basic concept–one we ignore all too often–is so easy. It is almost easier to follow this concept than what most of us do, but yet we still continue on.
What is this concept? Treat our patients with Respect, Integrity, and Compassion. The EMS Blogosphere is abuzz with EMS 2.0 discussion. Seems as though every one of my fellow bloggers has written an EMS 2.0 post–so I guess I HAD to follow.
For those of you who are living under a rock in West Texas, EMS 2.0 is:
EMS 2.0 is the global effort to reform prehospital emergency care. We are an open community that includes members of the general public, medical professionals, and policy makers. All of us are committed to reforming prehospital emergency care world wide.
Personally, I think it should start on a much more basic level.
Respect. Integrity. Compassion.
Respect.
It seems to me that medics have this God Superiority Complex that justifies the way they treat others–Our patients are scumbags, bums, drunks, and thugs. Our patients DESERVE what they got. Our patients don’t deserve good care. Our patients don’t deserve critical thinking. Why should I respect someone who doesn’t respect me?
Sure, we see a lot of bad eggs. Part of why we see them is the nature of BEING a Bad Egg. Bad Eggs do stupid shit. Bad Eggs make bad decisions. But…. Bad Eggs are still people. Do we expect the bad eggs to magically un-rot if we treat them like crap? Right…. Don’t get me wrong–I am not suggesting you coddle drunks and seekers. I AM suggesting that you don’t disrespect them. I AM asking that you don’t maliciously maltreat them. I AM asking that you give your patients a chance–now when they take that chance and piss it away by swinging at you, that is a new discussion.
I think that if we treat patients with respect, the image of EMS will only get better. Often we have this public persona that we are lazy, dirty drunks–much like the patients we hate–yet we don’t do anything to improve this image. It is OUR responsibility to ACT professional, and Respecting our patients is the foundation of that.
In the Movie, Sam doesn’t shove anyone down. As a matter of fact, it is striking how much he tries to NOT disrespect anyone. Our patients deserve to have a care provider with this dedication–yet often they end up with far less.
adherence to moral and ethical principles; soundness of moral character; honesty.
I think the easiest way for EMS professionals to honor the integrity of our patients and act with integrity ourselves is to Follow the EMT Oath. What you say? We have an Oath? Yup, and while we might not put our hands on a bible or be sworn in like some public servants, we are still obligated to uphold this Oath.
Be it pledged as an Emergency Medical Technician, I will honor the physical and judicial laws of God and man. I will follow that regimen which, according to my ability and judgment, I consider for the benefit of patients and abstain from whatever is deleterious and mischievous, nor shall I suggest any such counsel.
Into whatever homes I enter, I will go into them for the benefit of only the sick and injured, never revealing what I see or hear in the lives of men unless required by law.
I shall also share my medical knowledge with those who may benefit from what I have learned. I will serve unselfishly and continuously in order to help make a better world for all mankind.
While I continue to keep this oath unviolated, may it be granted to me to enjoy life, and the practice of the art, respected by all men, in all times. Should I trespass or violate this oath, may the reverse be my lot.
So help me God.
A big part of Integrity is Pride in one self, pride in your profession, and pride in what you do. If you are missing one of these parts, maybe this profession isn’t for you. Maybe someone a little more disconnected is your cup of tea. These aren’t optional parts of doing our jobs the RIGHT way. If we can’t act with honor, why bother?
Compassion.
Likely the most underused tool in our “kits”. To do this job for a long time you almost have to disconnect from your patients. The things we see and do are hard on the strongest of hearts, let alone one who allows them to eat you up. What that doesn’t mean is that we should disregard the significance of the moment for our patients. Our patients are in pain, dying, sick, or injured and it is our job to assess, treat, and transport them to the next level of definitive care.
Assess, TREAT, and transport. Treating our patients doesn’t have to involve and IV, medications or the LifePak 12. It could simply mean providing a compassionate ear to calm them down. More often than not, my patients don’t need any “medical” care, yet few people outside of medicine are prepared to offer them what they need. They need someone who has “seen it all” and able to reassure them, comfort them, and be honest with them.
BE HONEST. Compassion doesn’t mean making false promises. You should all know better than to go all TRAUMA on me and yell at your patients for dying or promising they’re gonna live. If they’re gonna die, you don’t have to say “Look, you’re dying”, but you NEED to make them aware(obviously if lucid) of the severity of the event. You MUST be compassionate and part of that is being honest. Tell them what they NEED to know. Tell them in a way you’d expect me to tell your mother.
Sure, EMS 2.0 is about a lot more than all of this “simple” crap, but what point is there in wasting the effort to improve the rest of EMS if we aren’t doing the bare minimum for our patients. The smartest, best groomed medics can still disregard the simple basics of patient care.
In the end of the day, if you aren’t treating your patients the way you’d expect me to treat your 85 year old mother, step back and ask yourself WHY? Then fix it.
If you haven’t seen I am Sam, you should. Sure, it’s sappy and silly, but honestly there is little excuse for us to not all live with the same Love and Care for others that Sam does for his daughter Lilly. Either we decide to do our jobs with Honor, Respect, Integrity and Compassion, or we’ve decided to insult our patients AND our colleagues. What point is there in improving the rest of EMS if we can’t address the most important part?
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!
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!
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!
“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”
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?!?!?
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.
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
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
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
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.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.Assessment is the medical skill. Without that, nothing else matters.
Not much reason to believe that spinal clearance patients need to fly.
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?
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.
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.
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”?
