‘EMS’ Archive

Mar

Code 3 for the Headache – Sudden

…and it’s contagious.

 

THE EMERGENCY

A headache!  Won’t someone think of the children?!

 

THE ACTION

I’m cooking tonight and the chicken enchilada casserole will be OK cold I guess.  The bells ring and we’re out the door code 3 for a headache, sudden, worsening.  It suddenly occurs to me that the sensation that develops behind my eyes between the kitchen and the engine is likely worse than what we’ll find on scene.

She’s in her mid 50s and is quick to mention her disability status (we noted the handicap placard in the BMW in the driveway) and her husband confirms it.  The disability status that is, not the headache.

Not one to take a patient at their word we do a full work up including 12 lead ECG which aquires a normal tracing just as the ambulance I downgraded arrives.

The patient’s headache seems to have subsided.  The pain that was an 11 is now a “tolerable” 7 although we all know that means nothing without knowing her 10/10, which she refuses to share…none of my business and all.

Turns out she had a bad tooth and got some medicine for it.  I know what you’re thinking, but no, she actually filed the prescription.

It was when the pain remained 30 minutes later that 911 was called.  And the call made it through the call center because of the words “dizzy” and “can’t think straight.”

 

Thanks MPDS, you win again.

 

Back at the house the casserole was cold and I lost the dinner shake, meaning I had to cover the cost of everyone’s meal.  That was a sudden headache.  I did not call 911.

 

 

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EMS,Patient Care
Feb

Not Lost in Translation

I’m not one to name drop on this blog, just ask my good friend Kelly Grayson.

 

That being said I had an interesting conversation with someone who shall not be named who stopped by my Medical Director’s office on Friday.  In from out of town he was curious about or current ramp up to pick up another 10-15% of the response market share and how we were planning on doing it.

Phrases like workload, UhU, time on task, staggered starts, logistics gap and dozens of others were immediately understood by all 3 parties and the conversation was inspiring.  What we have been trying to explain to regulators, the field crews and the bean counters was immediately understood, digested and we got an honest review of our efforts so far.

Just as interesting was when this expert made suggestions on where to go next that we had already put in motion.

The entire conversation lasted about 2 hours and solidified a lot of our methods and decisions in a field that has 1000 different solutions for a half a dozen problems.  The great part about sharing ideas is that we all learn what works for some and not for others and can apply the successes while avoiding the mistakes.

He asked what our start times were, we answered.  We were doing it right.

He asked what our deployment plan was, we answered.  We were doing it right.

We talked about the difficulties ahead in justifying the plan that calls for more hires, more units and more equipment and he shared some ideas.  Now we can do it right.

I don’t expect every CFO to understand how UhU alone is a waste of time and that the return on investment is useless if we don’t directly collect our receipts.  Sometimes a chance to talk to someone who “gets it” can inspire you to keep fighting.

So what did I do?  I went on vacation.

See you in a week Internets.

 

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EMS
Feb

I’ve seen it all, we’re done here

I thought I had seen it all until today.

Every manner of injury, illness, presentation and patient seen, noted and documented.

Oh universe, I love it when you mess with my mind.

 

THE EMERGENCY

A bicyclist has been hit by a car

 

THE ACTION

Well, not exactly “hit” and not exactly “by a car” but at least there’s a bicycle involved.  Units are approaching from all directions downtown and traffic is thick as it is almost 330 on a Friday afternoon.  The bicycle messenger rider is standing, rather clamly, on the sidewalk near a stretch of street with cars inching forward, but none of them stopped.  At least not stopped as much as you’d expect for someone who just hit a bicyclist.

As we approach he’s holding his right arm with what appears to be a napkin, likely from the Chinese take out place behind him.

The assessment begins and we’re hard pressed to find any injuries consistant with a vehicle versus pedestrian.  We are allowed to get so deep into the assessment before discovering what happened because, as always, our question of “what happened?” is met with a 25 minute slide presentation about how he was following all laws, riding this direction from this place as he always does, blah, blah blah.  I used my patented “skip to the part where it’s an emergency” more than once and finally he explained the napkin on the arm.

He got bit.

By a dog.

While on his bike.

I did a quick double take.  On the bike, even crouched over his shoulder is a good 5 feet off the ground.  How did a dog-

And that’s when the delivery truck in the far left lane, the one right in front of us hit a pothole, tilted and gently scraped a no parking sign.  Judging by the sign and the scratches on the truck, not to mention the truck not stopping, happens all the time.

The dog was in a car.

It was hard not to stifle the giggles and my partner is a pro at getting the giggles out, so my next question was tough.

“Did you get a look at the dog?”

He suddenly had somewhere to be and rode away before we got his signature on the form, but I imagined him on his hipster bike, riding along in traffic and some dog out for a joyride just sniffing the air decided to see what the City tasted like.

 

That was a first.  And it reminded me that as soon as you think you’ve seen it all-BAM-sumpin’ new.

 

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EMS,Patient Care
Feb

Paramedic – A look back at the first 100 years – Part III

Now that the solar flares have passed and we’re all back topside we can continue on our jaunt through the history books looking back at the first 100 years since Paramedics were born of necessity and grew into the most valued public service since the Post Office was reinstated.

Today we look at the early use of the pre-cortex for Paramedics of yesteryear to check their work with Physicians.

 

Online Medical Control

Before the Cortex people accessed a maze of sites with conflicting information, often having to enter queries using digit tabs called “keyboards” which allowed them to access information.  From my research I have discovered that early Paramedics were rarely trusted to make decisions on their own and would access online medical control.

Since the Paramedic’s searches were based on their own impressions of what was happening, it was very easy for them to access the information they needed for the proper treatment of their patients.  It was not the same as today, where Paramedics are trained to act in all situations, but instead was a way for our lesser educated predecessors to ask for help on difficult cases.

This was also referred to as “WebMD” and was accessible from any screen in any community.  Before screens contact was made via telephone line or by radio.  I know it seems odd to call a WebMD for Online Medical Control without them being able to see the patient but apparently it was done quite often.  Some systems were very strict and even required Online Control for some medications.

You see, before Paramedicine was recognized as a specialization it was often relegated to those who could not afford to attend Medical School but still wanted to make a difference.  This WebMD allowed them to be trained quickly and work for far less than their skills were worth to the greater medical community.

After the influenza their value was recognized but up until then Paramedics still accessed the world web when needed, not unlike a wave consult for surgical consults of decades past.

It was a good tool for the time but seems to have held Paramedicine back in some communities for reasons I can’t discover.

 

Next time we’ll answer one of the biggest mysteries of early Paramedicine:  Was it really done by the Firemen?

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EMS,EMS 2.0
Feb

A new kind of intern

For the last two Tuesdays I have had an intern.

I can hear you now, “That silly Happy, he has a desk job, how can he have an intern?”

Well, a local High School has expanded and offered an EMS Intern position.  One of the local Rescue Captains has assisted in designing the program which will give this student an inside look at not just field time, but supervisor time, administration time, radio time and even a few days with the regulators (Remind me to ask her to ask about proof spine boards are a good idea.)

I am proud to announce she was officially bored out of her skull in the CQI office.  What we do can be distilled down to the high school level, but the finer points of QA (stop laughing already) can be lost.

“We apply the rules, regulations, policies and protocols to each chart and determine if variations warrant review, coaching, counseling or reprimand.  And after completing those reviews we analyze the results to determine trends and act on them.”

She was unimpressed (Seriously? Stop laughing.)

So we read a narrative I was reviewing.  It went a little something like this:

“Police activated EMS for man defecating on sidewalk.  Male present alert and oriented, steady gait near pile of human feces.  Male has no chief complaint and has no signs of traumatic injury.  Male states “Just cite me and go away” without slurred speech.  Male does not give consent to treat or to assess vital signs, threatens to pick up and forcibly relocate feces, EMS agrees male may leave area under own power.”

“Why did the cops call if he wasn’t hurt?” She asked.

“We’re working on that, but I expect your generation to get that sorted out for good.”

 

She had a chance to meet the Chief of EMS and talk to him a bit about what it means to be a Paramedic these days and looking forward.  He is of the same mindset as me, that we make bad days better and go home safe to our families who will never know the truth of what we’ve been through.

I told her that the gauge of a good EMS leader is someone who, when asked if they would go back to an ambulance answers “yes” without the slightest of hesitation.  You can be away from the ambulance for only so long I have learned and the farther away, the more you miss it.

 

Next Tuesday is her last day in the Administration track and we’ll stop by the fleet yard and let her observe a World Class System deploy to chaos.

 

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Administration & Leadership,EMS,EMS 2.0
Jan

Paramedics – The First 100 Years, Part 2

This is part of a series looking back at the 100 years since the 1966 White Paper that catapulted Paramedics from van driver to medical professional.  We’re looking at some of the urban legends and lesser understood practivces of those who came before us.

 

Cervical Spinal Restriction -

Very little exists explaining this torture.  Images found in my research show patients were restrained to 7-8 foot long thick wooden and plastic boards whenever they were found in or near a motor vehicle that had been in a collision, and even sometimes not.  The board was apparently to keep them from running into the street and being further injured.  One document I found referred to a “C-Collar.”  It can now be confirmed that Paramedics used to use a piece of rigid plastic or metal and wrap it around someone’s neck if their neck hurt.

I was also able to learn that it was applied if the Paramedic’s Company believed it was necessary.  Before 2030 Paramedics were seen as less than nurses and not allowed to assess patients completely and act in their best interest.  They followed little books that told them how to treat patients and often these books contained the same information from the big books they learned from.  I know it seems redundant, but it appears the belief was that having a set of rules that restricted their actions, the Company could better control the interventions.  One of the things in the little books was to use the collar for neck pain and the board to keep drivers from running.  My grandfather used to tell a story about being placed on the board when he fell at home and struck his head.  He’s old and forgetful.  Why on earth would a Paramedic, even an early one, strap a healthy curved spine to a flat board?  Sounds like torture.

I was also unable to find reference to the first 2 interventions, the A-Collar or B-Collar, I can only imagine they were worse than the C-Collar.

Next time we’ll dive into the concept of using the early internet for patient care with online medical control.

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EMS
Jan

Paramedic – A Look back at the First 100 Years – Part 1

2066.  100 years since the White Paper that solidified what some communities were already learning:  Paramedics were needed to help in communities that had no doctors.  We were born of trauma.  Accidental death was our crib and cardiac arrest our playroom.  In our adulthood we expanded into the community and dealt with chronic health issues.  Now reaching 100 years young there is so much farther we can go.  But to know where you’re going, you need to know where you’ve been.

It’s easy to forget where we came from.  Not just back to the ancient times when drivers had wagons and horses, or when the hearses (I still can’t believe we buried our dead) began to treat people, but at the decades that propelled Paramedicine into the respected Profession we practice today.

In this series I’ll be covering all manner of advancement in care, organization, education and funding, but I wanted to start off by clearing up some myths about the early days of Paramedics.  These are all 100% accurate, as I have referenced texts from the time.

Let’s start with one of the Urban Legends of Paramedicine:

Chemical reversal of death - It is true.  It can now be confirmed, based on texts from the day, that Paramedics (Often called EMTs back then) would inject patients suffering from cardiac arrest with cardiotoxic chemicals that they thought would mimic the heart tissue’s natural functions.  There were no balloon pumps back then and hypothermia had yet to become rapid onset using the sheaths.  Although they did begin to cool patients using cold packs and cold venous injections (transdermal fluids were decades away), many patients were likely inadvertently killed as a result of this practice.  Some research was recovered that showed dismal success rates, but it wasn’t until the H6N3 epidemic in 2023, when stockpiles of cardiotoxins were depleted and survival did not worsen, that the industry finally took notice and eliminated their use entirely.

It was the Paramedics that rose up during the epidemic that overwhelmed the hospitals of the day, which quickly became incubators for the rapidly mutating infection.  It was the mobility of the Paramedics that allowed for continued care when the hospitals shut down for months to be disinfected.

Combined with AEDs (ShockDocks) installed as frequently as fire extinguishers survival from cardiac arrest improved.  It was not the hospitals that led the change, but the Paramedics who fought for common sense technology in the community.  When MRI and Xray were still not in the patient’s home, they stood up and demanded change.

It is worrisome that it took something drastic for Paramedics to look at their own practices for efficacy instead of demanding proof before using it that it would do no harm.

 

Next time: A lead on the curious boards used to apparently keep drivers from falling into traffic.

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EMS,EMS 2.0
Jan

Ambulance Facility Must Haves

Many an article looks at ambulance design, Paramedic training, policies and protocols but I’ve been wrestling with a different kind of barrier to quality: The Fleet Yard.

 

More specifically, I was wondering what your must have list is for an ambulance deployment center.

 

Is it indoors, well lit, vending machines, training on site, locker rooms, showers, supply techs, drive through ambulance wash…

Here’s my must haves if I could build a brand new facility:

  • Drive through restocking and shift change
  • Onsite mechanical repair
  • Onsite scheduling, CQI and training
  • Indoor secured fleet and employee parking
  • Vehicle Service Techs for restocking
  • In-unit mobile data gateway repair (after I get them installed that is)
  • Crew lounge
  • Locker rooms with full showers
  • Gym

Let me know what your must haves are, maybe you’re thinking of something I’m not.

 

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Administration & Leadership,Administrative,Emergency Vehicle Operation,EMS,EMS 2.0
Dec

The hour is late

Recently a close friend asked why we even try.  Why do we try so hard to achieve all the goals we have been chasing?  Who cares?  Isn’t there someone else who can fill in what we’re doing better?

No.

No there isn’t.

If there was something better that could be done, we’d be doing it.

This forum used to be updated every few days, some days even multiple times a day.  My duties have consumed my time, heart and vision.  Previous posts about not being able to change the system have turned into meetings that are changing the system.  For every crazy story I try to tell, I read an actual chart that mirrors my edited version and the tale can’t be told.

We’re on the verge of some major opportunities in my system and that seems to be monopolizing my time.

Go figure.

13 months ago my priorities changed and this therapy experiment has suffered.  It was created for one purpose and one purpose only and that was to serve as a pressure release valve.

Boy did it ever.

But the pressure might be too high this time around.  The troubles aren’t with those in charge of the system, or the system itself, but within myself.  My dreams of an EMS 2.0 world were destroyed by regulators, bureaucrats and the realities of a for profit system only to be rebuilt by a single EMT doing the right thing despite our policies to the contrary.  Our late night discussions in Baltimore, Vegas, Houston and other places all build into a mural of a future for our Profession only to be sidelined by technical issues and personnel conflicts.

We were dreamers.  We looked at a future that was built around quality patient care, not realizing the first question would be “how are you going to pay for all that?”

I checked…the Police Department has yet to post a profit.

It isn’t an uphill battle we in EMS are fighting, it’s an all out war.  There are those who wish to take over, give up, concede, demand even take a seat on the fence and wait to see who wins to declare their allegiances.  We can get frustrated, rant, moan and complain or we can give 100% to the one thing that matters:

 

The patient.

 

My posts may slow, my twitter may stagnate, but only because I have a chance to make a difference for more patients and I’m taking it.

Join me?

 

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Administration & Leadership,EMS,EMS 2.0
Nov

Sideways

I am a big skeptic of putting the 2 people with the least ability to assess a situation in charge of the system’s response to a reported emergency, but until we change things they can only code what they are told, right?  And the caller is never, ever, EVER, wrong.  Especially when describing technical rescue.

 

THE EMERGENCY

A caller is reporting he has fallen over 50 feet and is unable to walk.

 

THE ACTION

I had to read it twice too.  First party caller has fallen 50 feet, unable to walk.  Should be unable to do most things after that fall, especially when he would have hit the ground at a decent pace, then suddenly stopped.  Stranger things have happened, right?

The dispatch rounds out, after us in the engine, the truck, medic, Battalion Chief and Captain, with the Rescue Squad.  Further questioning suggests the patient is trapped.  Never before have I wanted the TV version of EMS to be true so they could patch me directly through to the caller and figure this all out.

 

Arriving on scene my firefighter and driver are grabbing some hand tools and a long spine board when we all look around the address for a second, an old habit of sizing up burining buildings.  None of the surrounding structures, trees, even light poles are more than 20 feet off the ground.

Something doesn’t smell right.

The balance of the assignment arrives as we head inside, ready to treat trauma.

We found drama.

A middle aged man is sitting on a chair still on the cell phone with the call taker, no apparent injuries.  He is inside a single story building and the folks standing around him seem confused as to why so many firemen have arrived.  The rest of the units are cancelled as we begin to learn the tale of the “long fall.”

This gentleman tripped on the sidewalk and would like to know who he can complain to after we take him to the hospital.

“Why would you goto the hospital?” I asked, already knowing it was a mistake.

“For my injuries, of course.  I must be hurt if the ambulance took me in.  I’m on disability already and can’t be expected to get around on my own all the time.” Was his response as his cell phone rang.

The caller on the other end wants to speak to “whoever is in charge over there” and I LOVE these calls so as the EMT confirmed the appearance of non-injury I spoke to the patient’s wife who also heard what our call taker heard.

“He says he fell 50 feet!  He needs to be taken to a hospital or something, he could die!”

“Sir?” I was embarased it took me this long to put 2 and 2 together, “Where did you trip on the sidewalk?”

“50 feet up the block!  I couldn’t walk!  Go look at that crack!”

He kept giving the distance TO the fall, not OF the fall, hence all the confusion. GIGO.

After refusing to listen to our reassurances that an ambulance ride was not only unnecessary but would end up costing HIM money, he was taken to the local ED “to get checked out.”

While loading up the gear the engine boss decided to go have a look at the crack in the sidewalk that could end up being a killer.  About 25 feet up the sidewalk we saw a slightly raised seam that someone could indeed trip over.

So we taped it off.

Tragedy averted.

 

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EMS,Patient Care