Wednesday, December 21, 2016

Musings and Advice for the state I left.

 It has been a busy year and to be honest, I haven't had time to write much. The amazing thing is that I truly enjoy this and hope that my audience does as well. So given that it is the holiday season and a time for reflection, I am going to reflect now and hopefully provide some insight.

This has been a year of momentous change. My wife and I have changed states and she changed employers, for a major improvement. This year brought an end to an association I have had since I first obtained my paramedic cert. The hospital I functioned under the longest no longer has any affiliation for me. In fact I no longer associate with any Illinois based EMS agency. This has been a breath of fresh air, as the more I am free from Illinois, the more I see how bad it really is.

I have made steps to improve my health and happiness which are both working out well. The reality is, that without the above move, I would never have been able to accomplish this. I am more in control and have better support than I have had in a long time.

Now this is mainly an EMS blog and I am going to continue on EMS here. The more I see of Illinois EMS the more I now understand why the Indiana hospitals I transport to looked at me like I was an idiot. There has to be a standard change in EMS starting yesterday. Where to start, well read on my friend.

Let us begin with the term paid on call. If you are running an advanced service the term paid on call should be nowhere in your salary description. For that matter, Volunteer should not be there either. I know some fine volunteer paramedics, but in rural Illinois, professionals are needed. Now this change means that these counties might have to either drop back to Basic Life Support or, gasp fund EMS. This is the reality of the situation. Now, there is the flip side of this, no service should have their employees showing up in faded holy jeans looking disheveled and unkempt. Nothing says I am going to help you more than looking like the guy or girl who looks like they are going to a bar or about to mow the lawn. Appearance and attitude matter.

Next, accountability, if you are operating on an ambulance you are functioning under the orders of a physician. If said physician is not involved in service there is a problem. If you can't pick your Medical Director out of a line up, how can he have any clue what type of provider you are. This is the reality I have learned. Every agency should have a regular chart review, with said physician involved, as a part of their yearly continuing education. If your reviewing charts monthly and presenting case studies, Medics know that poor care will be noted and exemplary care will be acknowledged. This accountability also allows for protocols to be reviewed because it will show a need for changing them in a more expedient fashion

Finally, vehicle operations, I work in a city that a lot of Illinois services transport to. That means I get to see you coming in lights and sirens. You are likely driving too fast, not using Due Regard, and honestly not needing them most of the time. This has to stop. Not, this isn't entirely your fault. Rural Illinois EMS has this culture that Lights and Sirens are important. Well, considering the wealth of evidence that says time is not usually of the essence and that in a lot of those time sensitive situations, the Lights and Sirens create more problems due to anxiety and increased likelihood of an accident, stop it. I really do not want to respond to an ambulance accident, especially if it is someone I know. Oh and if it is a BLS transport, there is literally no reason to have those stupid things on.

As always,

Lone Medic.

Sunday, May 22, 2016

A Guest Blog from a Passionate member of the EMS community on Punitive Medicine.

My Thoughts on Punitive Medicine

      Nothing in EMS angers me more than punitive medicine, which can easily be defined as not properly treating a patient based on their “station” in life. I have recently heard fellow providers brag about using unnecessarily large IV’s, with holding pain management, and perhaps worse of all flipping a patient upside down on a back board. These acts, and others like them, are without a doubt deplorable. I am ashamed to call anyone who “practices” this type of medicine a colleague.

     I know we have all responded to that one address that calls at few times every week. What happens if this time the chest pain is not a cry of the lonely but an MI? You know the one that was missed because old Mrs. Jones calls for this very same reason at least three times every week so we didn’t do an assessment or talked her into refusing care because she’s just lonely? Sign here ma’am. Call us back any time. Empty words. Or how about the drug addict? Should we treat him any different because he’s asking for his problem and should be able to control his addiction? Then there is the inmate. 16-gauge IV just because we can, right? Single mom with three kids who called for a child with a runny nose? She should have taken him to the doctor Friday instead of interrupting our nap time. I could easily list several more examples.

       As professionals, we need to remember that every patient we meet is somebody to someone. Why is it we feel superior in our dealings with such individuals that we feel the need to pass judgement? How is that in any way our right? As professionals, we should not judge simply because we have not walked a mile in our patient’s moccasins. We cannot say “well I wouldn’t” because we have no idea how we would handle those experiences. Our actions, either appropriate or inappropriate, leave a lasting impression on our patient. How do you want to be remembered?

      First do no harm. I know that was part of my education in EMS, as well it should have been. It should have been part of your education too. It is my opinion that punitive medicine goes against the very core of this idea and is morally and ethically wrong. In utilizing punitive medicine, we lower ourselves to the least common dominator, making our profession look heartless and uncaring. Is that how we want the public to see us?

     I would like to close with two Bible verses. James 4:17 If you don’t do what you know is right, you have sinned. Luke 6:31 Treat others just as you want to be treated. Christian or not, good words to live by, not only as we take care of the people entrusted to us but also as we deal in our day to day lives.

Sunday, March 6, 2016

An open letter to St. Louis Fire

Dear St. Louis Fire:

                This is an open letter to try to help you and the city solve your ambulance problem. Allow me to qualify this with something I think needs to be stated, St. Louis Fire does an excellent job in delivering EMS. It is clear that your current model delivers excellent care and allows EMS to govern its own. You also have a robust mutual aid system utilizing your local private Advanced Life Support providers to ensure your citizens are well taken care of in times of system overload. Overall your system is to be respected.

                So here comes the criticism. I recently read that you are wanting to increase the taxes on your citizens to purchase several new trucks at a cost of two hundred and fifty thousand dollars apiece. Now, far be it from me to begrudge any ambulance upfitter the significant increase this will make to their bottom line, but I can’t see this as the best solution for the taxpayers of St. Louis. So I will try to point out a better solution.

                As a paramedic in a Urban setting, I understand the city can be busy and restocking can be difficult so there is a need for modular units. So that has to be part of your bid process. But in my humble opinion, wouldn’t the city be better served by moving to a type 3 Sprinter Modular unit.

              While it has been a while since I speced out an ambulance, but I would bet that a sprinter Type 3 with custom interior designed to your needs would save between seventy five and one hundred thousand dollars. It will also fuel costs and have lower maintenance costs. These savings could be used to put more crews on the streets improving coverage.

It seems to me that St. Louis should continue their tradition of proving that Fire Based EMS can provide excellence. Many places don’t hold up to scrutiny, but St. Louis has. The City of St. Louis, and its citizens would thank you. Please continue providing the amazing care you are known for.

Just a humble suggestion,

Lone Medic.