A Tale of Two Nurses

We get all manner of “medical” folks presenting on airplanes these days.  From the EMT student who manages a stroke to the PhD in Engineering more interested in free miles than the broken arm presented to them when the crew asked “Is there a Doctor on board?”

Recently we had a few runs that showed me the wide variety of medical training available to our nursing friends.

The first call was for a possible seizure on board the plane.  While responding we are told that a nurse is with the patient and will meet the medics at the door.  Well, gee, I hope so.

As the aircraft arrives we are met with a conscious, alert, oriented, ambulatory and very embarrassed patient.  The patient claims he awoke from a very intense nightmare and was shaking, but awake.  The nurse, who repeatedly made sure to tell us about her 24 years in the ED, proceeded to tell us about a “confirmed post ictal period” that included crying and wanting to get up and walk.

Of course the nurse denied this reasonable request.  Later, the patient told us he recalls the entire event and our assessment backed his version of events.  As he signed a refusal, the nurse did a double take and came running over to me.

“If he isn’t transported, you’re going to get sued you know.  He needs a Doctor.”  Then she went back to the counter to see about a flight coupon for “helping.”

Not uncommon unfortunately.

Second nurse encounters a child itching her foot.  The parents seem oblivious, but this nurse stops and mentions that the foot looks to be red and swollen.  Upon further assessment the child is, in fact, experiencing an allergic reaction from a bite of some kind.  She quickly pulled some of the Benadryl she carries and gave it to Mother to give to the teewn aged child.

As medics arrived at the scene they found a child with no complaint and a blue shape drawn on her calf encircling a small bite wound.  The nurse drew a line around the edema to track its progress, but it regressed before they arrived.

“Glad you’re a nurse,” my crew told her, “Do you work in the ED?”

“No,” she said shyly, “I’m a home health nurse.  I take care of an older couple.  You know, cook, clean, help them out.”

She got a high 5 from us, then simply walked away.

 

the Crossover Show – the Police Fire EMS Podcast is Back AND ALL NEW!

Your favorite (and only) triple threat podcast is back after a long hiatus that can only be explained with a 9 iron, Facts of Life Reruns and a life sized cut out of former Secretary of State Colin Powell.

Motorcop and yours truly are taking our first 51 shows and rebooting the franchise to bring you a more formatted show that will be perfect for your morning commute, the treadmill, or ignoring the kids for a good 40 minutes doing yard work.

The Link to MCPD for the show is here and after this you won’t have to worry about following along here, you’ll simply add us to itunes or your podcast player of choice.

To add us to your non-itunes player simply add the feed http://motorcopblog.com/feed/podcast.

We’re recording regularly so every Friday you’ll hear more topics important to those of us first in when things go bad.

Included in this new show are segments titled “Lineup/Briefing” “10-8″ “BOLO” and “AIQ/7SAM.”  We go through the show just like you go though a shift on the engine, cruiser or ambulance.

So click through, have a listen and subscribe to the show Good Morning America calls, “We do not review content.”

If you like what you hear please give us some feedback in the form of a rating on itunes (One star means you hate puppies).  The more positive ratings we get the higher we are placed on the queue (list for you cop types) and the more folks can hear the show.

So here we go!

The boys are back in town!

State Bill allows Nurses to Staff Ambulances

In an interesting twist the state legislature in Texas is considering staffing ambulances with nurses.

And I’m for it.

Let me explain:

There is a place for nursing pre-hospital but we’re going to need a complete retraining for the nursing staff.  Focusing on decision making without physician approval as well as adapting to adverse conditions will be needed and we in EMS are more than willing to help them prepare for this change in role and responsibility.

We need more specialized help in the field and nursing can help fill that void.

See Texas ENA, that wasn’t hard now was it?

For those of you not in the know, head over to Unwired Medic’s post for details about the Texas nursing group spreading lies to prevent medics from practicing in the hospital.

Before you grab a pitch fork to tear apart their hilarious claims, let’s turn the tables for a minute.

Could a nurse staff an ambulance?

The short answer is no.  The nurse has no extrication training, no patient movement training and no idea how to react to standing orders.

But if I needed their expertise in the field I’ll be the first in line to help them get trained up.  I certainly wouldn’t be the first to write a letter about how placing a nurse in the field would be unsafe and endanger patients.

That’s exactly what the Texas ENA did without thinking about, or researching, the capabilities of modern Paramedics.

We aren’t simply techs wandering the halls performing IV sticks and other random tasks.  If the Texas EDs need practitioners with experience giving medications, performing intubations and other advanced procedures and reassessing complex patients, why not choose a Paramedic?

We do those things in low light with little rest and no back up as it is.

Texas ENA seems to think that giving us comfortable shoes, bright light and a room that doesn’t move will somehow endanger patients.

Adorable.

Texas ENA is worried a technician with an associates degree can outperform their Nursing degree when the cards are down in a time sensitive situation.

You played your hand too early Texas ENA and are drawing for the inside straight.

We’re holding the Royal Flush.

We’re all in.

Do you call or raise?

PS – You should fold.

the Crossover Show Returns May 1!

This is not a delayed April Fools joke.

The Internet’s best (and only) Fire, EMS, Police crossover podcast triumphantly returns May 1, 2015.

Your hosts, the ruggedly handsome fire and EMS expert (yours truly) and the Po-po a go-go Traffic Enforcement guru Motorcop, are still in their beer drinking, opinion slinging moods but this time with intent.

We actually started planning out shows, guests, schedules…seriously, we even wrote stuff down.

Check your itunes feed as the first 51 episodes are down to make room for the glory that is the return of the Crossover Show!

Have a listen, give us a review on itunes or whatever other podcast player you use and enjoy the hilarity that is only possible when a cop and fireman don’t have to play nice.

Details on topics, guests and overall shenanigans in the coming days, but get ready internet…

They’re baaaaaaaaaaaaaack.

Happy FDIC!

I have arrived in Indianapolis for FDIC. After arriving late I got a text from pal of the blog Steve Whitehead from the EMT Spot.   In the sea of blue workshirts, FD T-shirts and hats was Steve and his cadre of friends. We talked as if we were all probies back in the day, instantly comfortable with stories, fishing tales and respectful disagreements on the quality of beer available at each establishment visited.

This is the side effect of FDIC that for too many has become the draw: Bars downtown overflowing with firefighters, scantly clad bar maidens and plenty of drinks.

Luckily for me, the nerd, our conversations went from training requirements, to wooden ladders to standardizing expectations on the fireground.

Eventually, and not long into the evening, Steve and I got that awkward question: “How did you guys meet?”

Our answer was quick and brought a laugh to us and a stare to them.

“Oh, we met on the internet.”

TODAY’S SCHEDULE:

1030
FDNY Deputy Chief Frank Viscuso’s class on his book Step Up and Lead. I hope to learn more about Fire Service Leadership traits (a theme you’ll see me chasing a lot this week). I chose this class based not only on the topic, but when the description mentioned “…elevate their ability to lead themselves and others.”

1530
Friend of the blog Bob Atlas from Fire Alumni fame is presenting 11 Essentials of the Company Officer. Not only is it a great topic I hope to learn from but I’ll go and support my friend by laughing at his jokes and offering a familiar smile.

I’ve got the 1330 slot open for now, debating some technical suppression stuff to break up all this leadership training.

Hope to see you here!

-Justin

PS, in case you somehow blinked…I’m presenting Friday.

FDIC image

Informed Customers and the Irrational Medical Marketplace

Leonard Rodberg PhD, penned an article in July of 2013 discussing why Healthcare in America costs so much.  His take on the system boils down to an often overlooked glitch that is required for a market to thrive the way we are told the Healthcare market should:

The customers have no idea the cost, the options or the necessity of the products they are being sold.

Imagine you are going in to buy a television.  The clerk in the store has only 1 and there is no price listed.  He tells you there may be other TVs, but this one is the best fit for you.  You’d be out of that store in a heartbeat looking for a store with more choices, pricing information and make an informed decision.

Healthcare overall is still being treated like a product to be sold instead of a service to be delivered.  The Marketplace set up to handle payments for service can not work if the end user is purposefully being kept in the dark about pricing, options and alternate methods of care.

I’m not talking about healing crystals, but instead trying to focus on the actual end game for healthcare:  Healthy people.

A healthy population is more productive and costs far less in the long run in regards to care so why aren’t we making a difference?

Shouldn’t our goal be to prevent larger problems early?  What ever happened to an ounce of prevention being worth a pound of cure?

Turns out an ounce of prevention means a loss of billable services later on.

Jeffrey Brenner, Physician and co-founder of a group researching new methods of delivering care called the Camden Coalition of Healthcare Providers, was recently a guest on Freakonomics, a show about the hidden meaning of everything.

On that program he discusses his group’s efforts to find high users of healthcare and address their problems head on.  By making them healthier, they use less of the system.

From the show:

“So we learned that 1 percent of the patients is 30 percent of the payments to the hospitals, and that 5 percent of the patients is about 50 percent of the payments to the hospital. So a very small sliver of patients are driving all of the revenues to the system. … And you know, the question really is this the fault of the patients or is this a system failure? And I think our journey over the last couple of years has really demonstrated to use that it’s a system failure and that we could be doing much, much better for these patients.”

If we suddenly improve the health of 5% of the people visiting the hospital, just 5%, that hospital will lose 50% of their revenue.  There is no incentive to cure these people.  The same can be said for EMS.  If we actually start telling people they don’t need an ambulance we lose our revenue stream and can’t operate when someone does need it.  Of course that logic only holds if you consider EMS a product and not a service. (Here’s a hint…the word Service is actually in EMS.)  Until EMS is considered a service just like police, fire, animal control and the courts it will be driven by profit and profit alone.  New methods of care will be challenged with “What is the reimbursement model on that?” instead of “How many people do you think we can reach and improve?”

Sounds a lot like some programs sprouting up recently, doesn’t it?  Community Paramedicine needs to be that tool for EMS, but may get cornered into simply visiting folks post discharge.

In the meantime we need to change the way we deliver care.

We need to start educating our patients.

Ever been told by your managers or Chiefs not to discuss billing, costs or any other financial aspects of care?  Why do you think they do that?  Could it be that finding out the cut finger will be billed $1700 may impact the patient’s ability to make a good decision or is it that the manager and Chief need the $355 State payment for the transport to keep the system afloat?

You know it’s the latter but will still tell patients, like I used to, that worrying about money should be the last of their worries.

Or should it?

If patients knew the cost of the service they requested, were given options at various levels of cost that fit the situation and were able to choose a solution that met their needs, that would be a true marketplace and the cost of healthcare would fall dramatically while maintaining the same levels of care to those who need it.

We operate in a marketplace that hides cost, reduces choice and intentionally restricts access to services.

That is an irrational medical marketplace indeed.

Now in the Keg – Basic Ale

HA!  You thought I stopped brewing didn’t you?

 

No you didn’t.

A return to the basics this time.  An American Ale kit from More Flavor with California Ale Yeast.  No frills, no extra hops (Gods forgive me), just a basic simple beer brewed the week of bad news and ready to drink the day of worse news.

Sometimes the simple things are the best.

Slainte.

Basic Ale

Happy Medic at FDIC! Schedule Details

I have the honor of speaking at FDIC this year and am excited to share the details with you!

Classroom Session:

Social Media: The Rules are Already on the Books

Friday 1030–1215

Room 107-108

In a world swimming with social and sharing media, a chief officer may be inclined to apply a blanket blackout policy to social media. And he would be wrong! The focus of this class is to guide chief officers and company officers in applying pre-existing rules to new media, directing negative online actions into positive ones, and harnessing the power of sharing media for their benefit. Students are given the tools to apply the real world to rules already on the books and to understand the new generation and its desire to share  as well as the older generation’s reluctance to share at all. ALL LEVELS

I also plan on attending a number of classes beginning Wednesday and of course the end cap for the trip: INDY ON FIRE hosted by our old pal Fire Critic Rhett Fleitz

An Unexpected Compliment

While walking through the kitchen to the comm room to talk to a co-worker, I walked past, and wished a good afternoon to, one of my co-workers.

She stopped me and said, “I have never seen you move without purpose.  You always have someplace to be and you’re going there like it matters.”

 

Possibly the best compliment I’ve gotten in a long time.

Cash on Delivery – American Healthcare from the Outside

Those of you following along know where I work and why I can no longer mention them.  For you new people, I work at one of the busiest airports in the Nation and the world.  I meet all types of people, from the college kid traveling home on the puddle jumper to the executive boarding early for champagne on the A380.

I meet them all at one time or another because of a tight travel schedule that didn’t leave time for lunch, a few too many $12 mugs of beer at the terminal, a bag falls from the bin or, on the rare occasion, their pilot isn’t able to bring the aircraft in for a controlled stop.

Most times we encounter a person dehydrated, intoxicated or suffering from a minor traumatic injury.  Like any other EMS service we respond, assess and offer treatments and transport options as appropriate.

It was the summer of 2009 when my discussions with Mark Glencorse, then a Paramedic in England, turned towards the American and NHS systems of care.  In the US we were being told the British were being turned away at over crowded emergency rooms and old women were laying in the street to die.  Mark was being told that in America if you didn’t have cash money the ambulance would not take you.  This opinion was confirmed on multiple ride alongs with Mark in England and, most recently, at my current job.

THE EMERGENCY

A pilot has contacted the tower declaring a medical emergency, person unconscious and they are on final descent.  ETA to terminal, 5 minutes.

THE ACTION

My crews are at the jetway as it lurches to life to approach the aircraft that appears to be pulling into the gate rather quicker than most.  Sometimes the pilot will call in CPR, other times you are met with a door opening and the sound of “three and four and five…”

Meeting us at the door the crew informs us that the patient merely fainted at the rear of the aircraft after getting up from their seat after the final descent began.  She’s in good spirits, embarrassed, but in need of further physician evaluation and she agrees to it.

As the local ambulance company arrives she is digging through her purse rather intently.

“We have your passport if that’s what you’re looking for,” I mention to her, softly toughing her arm to distract her from the task.

“Oh, I know, but I need to pay for the ambulance.”

The looks that flashed around the room were of disbelief on all faces but one.  Mine.

I crouched down into her line of sight and held her hand.

“You don’t have to pay right now.  I wouldn’t be surprised if NHS picks up the tab, but they’ll take you in and get you well for no fee up front.”

Her face was considering my words when I realized some background was in order.

“I had the chance to serve a week in Newcastle Upon Tyne with the Northeast Ambulance Service and heard folks from that region concerned about American medical access.  Rest assured, you can get care without cash in hand.”

She sighed heavily as the cot finally reaches her side.  As she was covered with a blanket and my business card tucked neatly behind that of the airline supervisor in her purse I heard her tell the ambulance Paramedic very softly “He told me not to give you any money now.”

To his credit, the medic quickly whispered back “I’ll make sure the hospital knows to contact the NHS for you.”

Her smile likely reversed the condition she was suffering from while the rest of us packed up and headed back to get ready for the next call.

Preconceptions can cause trouble.

Remember?