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.

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.

Not my nicest post ever.

                Arrogance, ego, confidence, terms that are often used to describe paramedics. What is rarely discussed is the people behind the title and how they impact the profession and themselves. We all know the guy who has yet accept anything that wasn’t done in his course. Fellow Blogger Ambulance Driver calls this one year of experience twenty times, by the way, if you haven’t checked out his blog you should. We also know the guy who can constantly quote the newest research and is either breaking protocol or getting orders to do what he wants because he can back up his ideas. From a coworker perspective both of them are frustrating, but let’s be honest, no one wants that first guy taking care of their family.

                Most paramedics fall somewhere in between. They are not actively seeking the best knowledge ever, but they do know that things change and accept it. If you are this guy, don’t hate yourself because you are probably going to be considered a reliable employee, be well liked  by your peers and do a lot of good. This is not a criticism of you.

                There is a need to criticize and worry about the person who hasn’t sought out new knowledge or accepted it. When you are constantly looking to find a reason to defend a practice as barbaric as full spinal immobilization, you are this guy. You can quote all of the cliché’s and not know any of the truth behind them. You sir are a menace to my profession and need to find a less dangerous form of employment. Please, for your patients sake.

                Then there is the research guy. You coworkers tolerate you, because you are often right, but when you make a mistake it tends to be larger. That being said, you do err on the side of your patients. Your problem is you are not considered a team player. You are great at work, but dinner with your coworkers, not so much. Often discussing a ball game, movie, or band is impossible. Here is advice, go see a movie. Let EMS go away for a little while. Remember that there is life outside of the ambulance. Believe me, you can still catch up on research and still enjoy things. Remember Isaac Asimov and Albert Einstein loved the three stooges. Nyuk Nyuk Nyuk.

Sincerely,

Lone Medic.

Sometimes things are hard to say.

                People who know me are aware of my strong support of science and evidence based care. If you’re my friend you know that as long as you don’t betray the friendship, I am there when you need me. So when I recently discovered that a friend of mine was being treated unfairly because of ignorance, it wasn’t surprising to those that know me that I was irate.

                Clint Moore is a Paramedic for Air Evac Lifeteams, a flight service that does a lot of good including educational outreach that has improved the knowledge base of many providers. When Clint learned he was HIV positive he was taken off of flight status, and told he would have to gain approval of multiple states to regain this. I understand that this is likely due to state rules, and Air Evac was stuck in a situation because of this, but the very idea that a Paramedic with HIV is a threat to his patient is both statistically unlikely and an insult to the professionalism of the Paramedics and Nurses that make up these teams.

                A quick review for those of you that are unaware of this, HIV is a blood borne pathogen that requires specific vectors for transmission that would necessitate a healthcare provider to intentionally infect a patient. Accidental transmission in a clinical or prehospital environment would be nearly impossible. Basic BSI precautions, which are used on every call, will prevent this.

                The reason I state this is because there are laws in place that prevent these providers functioning. Laws like this serve only to punish these people, and prevent good providers from performing the duties they are educated and qualified to perform. The only reason laws like this are on the books is due to the fact that the most common people infected with HIV are homosexual and bisexual men, a group that is still commonly looked down upon. It is legalized discrimination.

                So when my friend found out he was infected, he reported his status and was punished, despite the fact that he was not a serious risk to his patients. Because of archaic and bigoted rules, if you act in a responsible manner you become more likely to punished, than if you just keep your mouth shut. That is pathetic.

                That is the technical and legal side of this. Now let’s discuss the other side of this. Clint is not a friend I get to see or talk to as much as I like. Life happens and those that we are close to often leads us to be far apart. But this man is my friend. Clint has had his career and purpose stripped from him, despite the fact that he did the right thing. But, when he went public he found out something he didn’t know. His friends will be there for him. If you have this horrible disease, or know someone who does, make sure they know you care and are there for them. The stigma attached to it is known to make those afflicted feel isolated. They are still the person they were before this happened, and they likely need your support, friendship, and love more than ever.

Thank you,

Lone Medic.

The legacy of a man, Rest in Peace Dave Kaye.

                Friend, colleague, soldier, teacher, paramedic, convicted murderer, it would seem that one of these terms didn’t belong with the other. Well, allow me to tell you about a man named Dave Kaye. Dave was a flawed individual. A boisterous man who knew of the mistakes he made and never tried to hide from them. He instead chose to take another path and in the process proved that a man can change his destiny.

                When I first met this man, I never expected that he would influence as many people as he did. First impressions would tell you that he was nothing more than an arrogant, loud, and abrasive person. Till he got to know you, he was a bit standoffish. But if you wanted to learn, and he knew something, he was always willing to teach. From advice to a laugh he gave what he could and we all remembered this today.   

        

                Allow me to explain something here. Illinois used to have a program that allowed prison inmates to become E. M. T.’s. It was a successful program that lead to many people turning their life around. This program is no longer active for many reasons, but it was a success. I am a firm believer that we need to find ways to help those who are convicted of crimes reintegrate into society. This is what Dave did.    

                      

                Too many people found out about the bad part of who he had been and failed to recognize who he became. Dave owned his past, never making excuses or acting like someone else was to blame. Instead he chose to become better than that. I mention his past because unlike most paramedics, his legacy isn’t the lives saved or the families he comforted. His legacy is something greater, hope.

                Hope is what he embodied. Hope that a man doesn’t have to be defined by a horrible mistake. Hope that choosing to be different can lead to a better place. Hope that redemption is possible. Dave lived the statement, YOU CAN BECAUSE I DID.

                I come here saying this because on April 3, 2015, this man passed on to his eternal reward. In the back of the ambulance today taking him on his final trip, we laughed telling stories of this man. We all realized how he influenced us all. Too often we forget that the most important part of the journey is those who we teach and those we inspire. The end is that we are not ruled by the mistakes we made and we can all change.  Dave my friend, rest easy brother and enjoy your rest, we have it from here.

As always thank you for reading,

Roger Morgan

NRP

An Open Letter to Holly Monteleone

Dear Holly,

     I am writing this to express both gratitude and disappointment. For what it is worth, allow me to state that you are a good representative of EMS overall. You present yourself as a compassionate caregiver and professional Paramedic. You do EMS a great service and as a father and husband of EMT's I am glad to a strong, intelligent, positive female being put forth as a provider. Thank you for this above all else.

     EMS has needed someone like you to be highlighted. Your performance makes us look good while showing that being a burnt out miserable individual is not what we should aspire to be. Your demonstration that good patient care and being positive are needed. Personally, your being inked shows that those of us with tattoos are capable of being professional and courteous. Add in your being well spoken, intelligent, and attractive and we have a rock star paramedic.

    This is why I was disappointed in what you having a negative attitude about Dr. Bledsoe and his criticism of the PAF t-shirt. While overall I consider PAF to be a positive group, as in they tend to not attack science and are great in supporting needed EMS ideals such as the Code Green Campaign. But the T-Shirt that was pointed out is something that while it might seem fun, has a negative impact on the profession. I will go even further if PAF was private I would consider it to be a necessary page.

    Gallows humor and venting frustration is healthy, but I tend to be critical of these things in a public forum. The public can't understand it, and often sees it as being uncaring. I am a small time blogger and this is part of my personal way to relax and blow off steam. But I saw this and felt I should point out that you are now the face of EMS. No individuals like Kelly Grayson, Chris Cebellero, or other provider. You are on television and highly visible. There are those out there that would tear you down. There is a likelihood that you will wind up interviewed on EMS issues. In short you represent us all, and we could do a lot worse. Thank you for reading this if you do, have a great shift, and stay safe my sister.


Roger Morgan

Lone Medic

Depression, Change, Friends, and Recovery.

It has been a while. During this time I have changed jobs, had some family problems, and I fell back into the an old enemy, depression. We in EMS are big on hiding from our pain and acting like it doesn't affect us. We often hide through substance or self abuse. I personally became aware of it when I snapped on my wife and made an inappropriate statement in front of a patient. These are out of character for me, and this showed me that I was having a problem. My old pal depression was back.

Depression is an affliction that strikes many in EMS. We are told to get tough. If it shakes you, then you are in the wrong job. You should not allow yourself to become that close. Just put it behind you, you can't do anything about it. But that doesn't work, because to be good at what we do, we have to be able to empathize with our patients. Empathy requires that we feel. It cannot be faked or compensated for.

So on to my story, when I was shocked into action, I started reaching out. Many of those that listened to my private rants and offered help are members of the Code Green Campaign. I was also offered assistance from my employer, which was welcome. My employer has a plan in place to assist employees in trouble that is available from day one.

So far, I have been able to avoid medication, but I was forced to do some serious introspection and evaluation. I am doing better, but I am still considering medication. I am going to share some of the things that helped me. The most important thing was to admit that I was depressed. You cannot beat this or even fight it without admitting it. I know people that have ruined their lives trying to drink, use drugs, or sleep around till they feel better. This does not work. It will make things worse, causing often irreparable damage to you relationships, the very ones you will need to ensure you make it through this.

I took a step back and examined what I wanted to do with my life and was EMS part of it still. I recently changed jobs, and increased my commute for slightly less money, but it was improved by the increase in benefits. I also had a truly private problem, that I will not discuss here. But in changing jobs I left the state I started in. I was not happy working under the system I was in. Even though the system was systemically broken, I felt as though I had given up. That was part of the problem. I had also labored under that system with the goal of changing it. I had to leave.

So I took I reached out to those who were on my side. I talked to people who had been through it. I also read some articles that allowed me accept that my emotional involvement was a good thing, something I should have remembered. Also I was reminded that leaving is sometimes necessary for perspective and growth. But it made me feel like I was a failure. See in leaving Illinois, I realized I had to abandon that fight from the frontlines. It was like a divorce. Probably for the best, but still feels like a failure. So I am winning the struggle. It isn't over yet, but I am happier now.

The following blogs are part of what helped me.

http://www.ambulancedriverfiles.com/2007/07/27/perspectives/

http://www.ambulancedriverfiles.com/2007/06/23/grief-sponge/

http://www.ambulancedriverfiles.com/2007/07/24/seeking-words-of-balm/

http://thehappymedic.com/2014/04/suicide-know-when-to-ask-for-help/

http://www.lifeunderthelights.com/2009/10/28/dear-state-of-illinois-emshellip/#sthash.uyFvxhfj.dpbs

These are but a small amount of the EMS blogs out there that I read. They allowed me to accept that I was ok. Changing jobs, feeling pain, these things are ok. Asking for help when it hits is ok as well. Sometimes, you have to understand that you can't change the world alone. If you are a provider that is in this place. Message me on here. Ask your friends Ifand employer for help. Talk to someone. You are not alone. EMS Suicide it a disease we inflict on our own. I refuse to be in that statistic. I hope you agree.

To those who helped me, actively or passively thank you. To those who are in trouble, you are not alone. Please visit and donate. These folks do good work.

http://codegreencampaign.org/

Thank you for your time,

Lone Medic