Category Archives: Mutual Aid News

The 3 Real Reasons EMS isn’t Ready to Refuse Care

Sean Eddy from Medic Madness, and fellow Uniform Stories contributor, has a new post up titled “3 Reasons EMS isn’t ready to refuse care.”

Go have a read, then come back for my comments.

Well, you’re either ready to storm Sean’s gates with your sharpened pitchfork or ready to defend him from what I’ve got to say on the subject.

Sean brings up some great issues that have been bouncing around EMS circles for decades.  With the recent introduction of Community Paramedicine and the concept that we can, gasp, leave people at home in certain situations, EMS providers are looking to build on the outdated “Transport them all and let the ED sort it out” mentality of the 1970s.

Sean’s 3 reasons are certainly worth discussion but I think he was very careful to sidestep the elephants in the room.

l’ll address Sean’s reasons 1 by 1, then give you the 3 real reasons we’re not refusing care.

Sean’s Reason #1 We’re not trained for it.

I’ll agree with Sean here on a handful of cases.  I would argue that leaving a hyperventilating patient at home simply telling them “It’s just anxiety” without addressing the symptoms we aren’t ready for, nor should we be ready for.  However, this skips over the other 99% of our calls.  When a person has an injury or illness (or nothing assessed) and asks us “Do you think I need to go?” we should not be bullied into transporting by a management who only gets paid if the wheels turn and a nurse signs the chart.  Honestly answering that patient’s question and giving them the information they need to seek the care the need should be job #1.  We are trained for that.

Sean’s Reason #2 No Legal Protection

This is one of the urban legends of respond not convey, that somehow, somewhere, we’re simply going to pull up, roll down the window, tell the person to just go to the ED and drive away.

There is not added liability in obtaining a refusal for a stubbed toe after telling the person that they don’t need to go in an ambulance than there is in obtaining a refusal after telling them they should.  Zero.  It is simply changing the amount of accurate information available for the patient to make an informed decision regarding their are.

Sean’s Reason #3 – We aren’t designed to be the end point in care

Sean brings up an interesting point that we are not meant to be the definitive treatment for patients, that that is only done by MDs.  Then I would call into question each and every refusal of service ever collected in the history of EMS.  We should be, and currently are, the end point when necessary.  Again, we’re not talking about chest pain, stroke, abdominal pain of unknown etiology, those patients are all obviously in need of evaluation and we are not their end point.  For the finger smashed in the door of the car we are also not the end point in care but that is no reason to REQUIRE ambulance transport to an Emergency Department.  I can’t fix the finger, surely we can agree, but there is nothing I can do beyond splinting and supportive care.  In addition now we’re sending an urgent care level patient to an ED, grossly over triaging “just to be safe.”

 

Sean is a friend and don’t take my comments about his concepts as disagreeing with him.  He and I have discussed this topic repeatedly, as many of us have, and it is of course far easier to comment on ideas than come up with them.  But we all need to be realistic about the REAL reasons EMS is not ready to refuse care.

Real Reason #1 – There’s no profit in it

Oh, there’s reduced cost in it, but no profit.  Spending 30 minutes on scene for a refusal is not nearly as lucrative as a 30 minute transport.  There is no increased liability, no increased training required, no fancy advanced classes or licenses, we just have to do what is right and allow the patient to make good decisions and seek out appropriate care in the community.  But so long as insurance only covers transport, it won’t happen.

Real Reason #2 – We don’t understand liability

Leaving Erma Fishbiscuit at home isn’t the problem, it’s transporting her for no reason to an ED for no reason “Just to be safe” that is the liability.  We remove needed resources from the system to satisfy decades of urban legends from the anchors about so and so who broke the rules and left someone home to die, but never about how no rigs were available for Mr Johnson yesterday.  If the rules were broken and something bad happened, it isn’t the rule that is the problem.  We shouldn’t be scared about letting patients make decisions.  We inform, they decide, we do our best to get them what they need, we complete a chart and go away.  Just like we do now.

Real Reason #3 – Adrenaline and turnover

No EMT wants to sit in Erma’s house for 30 minutes making sure she knows where her medications are and when they should be taken.  No Paramedic wants to sit with Mr and Mrs Jones and explain how their daughter’s nebulizer works.  They’d rather hit the lights and sirens, break hearts, save lives and take’em all and let the Doctor’s sort them out, after all “We don’t diagnose.”

 

EMS is having a real problem taking itself seriously recently.  I applaud Sean for making his list and putting it out in the public.  We have a decision to make in the very near future and that relates to the future of EMS and I see it will divide us even further and I think it’s a good thing.

Yes, I said dividing EMS is a good thing.  More to follow.

-HM

Would I make a good Cop? Find out what Motorcop thinks

Get over to Uniform Stories to see if my buddy Motorcop thinks I’d make a decent cop.

 

Spoiler alert:  You know I’d get lost on day 1.

Now at Uniform Stories

Your pal Happy is proud to be included as a guest blogger over at Uniform Stories.

Uniform Stories allows you to upload a video about your experiences in uniform, no matter the type, and you know I’ll tell you that is a powerful medium.

Head on over and take a look at the site and watch a few videos and I invite you to upload your own.

If your uniform could tell 1 story, what would it be?

See you there.

SCHORR0-R6-037-17

Comments on ‘a flickering flame’ by Captain Chair Confessions OR How to confine burnout to the area of origin

Fellow EMS Blogger Captain Chair Confessions (CCC) has a post up that will likely sound familiar to anyone who has spent more than 10 days in EMS.

CCC is experiencing the first smoldering effects of burn out.

The reason CCC is going to recover and grow from this experience is their ability to come out and talk about it.  Granted, it’s more of a 1 way conversation considering the way the interwebs works, but it’s enough.

Simply recognizing something is happening is the first sign of recovery believe it or not.

I know CCC is feeling more than they are writing, and that’s OK, because everything will come out in the end.  Every emotion, every angry thought hidden by a forced smile with teeth clenched on a transport everyone knows is unnecessary, everything will see the light of day.

That flickering flame CCC is feeling is easy to ignore and is often missed because of pride.  Misplaced pride, but pride just the same.  We tell ourselves that we need to toughen up, grin and bear it, grow a pair or some other lie we tell ourselves and ignore the growing flickering flame.

Worst part is, at this small stage the flame is easy to extinguish.  Even the softest of breezes causes it to waver.  Believe it or not, simply saying your frustrations out loud can be enough to knock down the tiny flame.  Of course the fuel still remains and needs to be dealt with, but try taking a candle apart while it’s burning and you’re going to get hurt, spread a fire and be in worse condition than you are now.

The amount of fuel in EMS is staggering and I’ve seen shovels on both sides adding more.  Admin needs more transports to meet payroll, response times need to be faster, posting moves aren’t efficient enough…you know the complaints.  At the same time patients are getting less and less emergent and are calling more often looking for the quick service we’ve spent 40 years convincing them they needed.

Somewhere between a missed lunch and an angry call from the QI Captain you run a call like the one CCC had and the flame is back, flickering away in the back of your mind, ready to grow unchecked as soon as it can.

Don’t ignore that flickering, fluttering light.  Talk to someone, anyone, write a letter and throw it away, get the frustration out of your system.  Ever heard of screaming?  Go for it.  Find a local supermarket and ask them if you can borrow their walk in fridge for a minute.  Shut the door and scream.  Go ahead, I speak from experience when I tell you that the sky is a little brighter when you emerge.

From there attack the problem.  Get involved, get active and if things can’t change, then you have to.  Staying in a broken system that refuses to change isn’t healthy for you or your patients.  Move.

Again, from experience, it helps.  I got up, got out and landed somewhere where I eventually, just this last week, had a chance to rewrite our C-spine precautions policy.  And it might just pass.

It took a long time to get where I am, but the flickering flame I spotted when I got hurt was doused when I first stepped into this little room on the internet and began to scream.

And CCC is doing the same thing.

Keep strong Brother (or Sister)!

 

If you feel that flickering of burn out and want to vent, drop me an email, I’ll read it, or not, whatever, just talk to someone, anyone.

You’ll be glad you did.

“You should read this blog…” said the Medical School Professor

Our local teaching hospital / trauma center / STEMI center / stroke center is putting on a new lecture series which focuses on STEMI and ROSC patients.  It is very similar to the trauma seminar I’ve mentioned before and has a wealth of information.

It starts with our pre-hospital radio report and continues through the balance of care for the patients.

 

My favorite part was when the MD leading the presentation suggested everyone in the hall go to a blog for ECG knowledge.

Mine?  Of course not, not until the seminar on fart jokes and grammar mistakes.

No, he directed us all to “Tom Boot-hill-aye” and his excellent work at EMS 12 Lead .com.

I will admit I sat a little taller in my chair when someone I know was mentioned as an expert in his field…and uses a blog to disseminate it.

Sure Tom Buothillet speaks nationwide about the importance of pre-hospital 12 lead ECGs, among other things, but also uses social media and video to make his message more powerful.

Tom recently debuted the London Ambulance Service episode of CODE:STEMI where he travels the world talking about EMS systems and their reaction to sudden cardiac chest pain and arrest.

 

Good work Tom, keep it up!  I think you’ll get a few more hits from today’s session!

Rants may be Welcome, but Beware

A new site has popped up overnight (seems they’re coming fast these days) that is catering to a certain niche in our community:

The complainers.

Well, not really complainers, but those who need to vent.

I consider myself an expert on blog therapy and see this new site going one of two ways.

It will either be a tremendous hit or a disastrous flop, taking down the site owners, administrators and contributors.

It seems like a perfect idea.  Send in your EMS rant, they clean it up and post it anonymously.  Seems perfect.  Get it off your chest and move on.  They have all comments disabled, and with good reason, the troll factor would be incredible.

But, if a certain agency tries hard enough because they see something hitting a little too close to home, the entire house of rant could fall bringing every single poster into the light.

Be warned my friends, if you use this site you could walking into a delayed disaster.  But on the other hand, if you’re careful enough and can find some relief from getting your negative feelings out in a controlled environment (not at work or with a patient) who am I to stop you.

I’ll be visiting the site regularly, for the same reason I visit Fail blog, to watch the silly words and grab a smile.

 

EMSRants.com

 

Hey Motorcop, do you LEOs have anything like this?

Seems like the right time to say this too: I am not the owner or operator of that site.

Good Luck MC!

WikipediaTomorrow morning (Monday) our buddy Motorcop is taking the sarg…the seargean…the saarg…well, he’s looking to promote.   In an effort to help him out I was able to pull some strings and get some of the exam questions.

I hope these help!

 

Vehicle 1 is parked facing south 22 feet from a stop sign in a 25MPH zone with hazard lights activated.  Vehicle 2 is traveling south at a speed of 35 MPH wit ha driver holding a cell phone to his head.  If vehicle 2 impacts vehicle 1 after applying the brake pedal for 20 feet, how far away is the Starbucks?

 

A male has been witnessed peeking into windows at the local yoga studio.  When you arrive on scene do you,

A) Detain the man in the london fog coat looking into the window.

B) Question the man in the london fog coat looking into the window.

C) Tazer the man in the london fog coat looking into the window.

D) Point out to the studio owner that their window faces a public street, the blinds are open and it’s daylight.

 

One of your patrol officers fails to report for duty.  Phoning his residence there is no answer, but he answers his cell phone.  He states he is sick and notified the night Sergeant, but in the background you hear an airport announcement.  Do you,

A) Notify him he is in violation of Dept regulations and begin suspension paperwork.

B) Accept his statement and place him off sick, then call in a cover.

C) Call the night Sgt to confirm the story.

D)  WTF guys? Am I not invited on the camping trip again this year?

 

CVC 21100 addresses _______________________________

A) The size and location of mud flaps on commercial vehicles.

B) The allowable length of overhang of an object protruding from a vehicle before it needs to be flagged and lighted.

C) Electric vehicles on sidewalks

D) No one is ever going to look it up, just pick something random.

 

And the question weighted most heavily on the exam:

Responding to a reported man down you arrive to find the local town drunk an inebriated fellow.  Do you,

A) Dismount bike in manly fashion making sure all civilians see the stripes.

B) Assess the situation after growing a bad ass mustache.

C) Ensure the man down is breathing and if not, begin life saving efforts

D) Stand over him, hands on belt and shout “Stay down! The heroes are coming!” after calling for an ambulance.

 

Good luck MC, we’re all rooting for you!

the Prosthetic Medic

There has been scuttle around the EMS interwebs as of late and I’ve linked to this little blog from my little blog but have been having trouble finding the right words to describe what Joe Riffe is going through.

I’ll link to his site in a minute, but he’s been in the sidebar for a few weeks.

Joe can better tell you about his past, I’m more interested in Joe’s present.

You see, Joe is recovering from the amputation of his left leg above the knee.  Had this been me, I would just curl up in a ball on the floor and ask for water occasionally.

But not Joe. Joe smiles, gives a double thumbs up and asks the Universe, “Is that all you’ve got!?”

To say that his spirit to overcome this tiny lifestyle change is an inspiration does not do justice to how I feel when reading his day by day accounts of living with and around having only one leg.

Recently a child began to ask what happened to his leg and the child’s parent whisked them away without an answer.  He’s been called a cripple.

I call him brave.  There isn’t another word to describe someone who faces this kind of setback and charges forward, guns blazing, kicking ass and taking names.

When life seems rough at HMHQ I often think back to the days before kids, or maybe when we lived in the City, perhaps even before this staff job finds me in traffic 5 of 7 days, but I can get up, walk somewhere else and change my life if I want to.

That is what Joe is teaching me as I read his accounts of life with one leg.  Sure there are awkward moments like,

How do I pee without falling down?

Do I need a wheelchair?

Will I wear shorts again?

 

But it makes me step back and wonder what in my life is really bothering me.  Joe didn’t set out to inspire me to reevaluate what’s important in my life, but he is.  My take on his story is a selfish one for sure, that’s just who I am, but this story has really set into my mind to make me think more about what I have, and less about what I think I want.

Joe is about to walk into a whole new chapter in his life with his head held high and I’m honored he’s letting me come along.  You should too.

 

If Tim Tebow was a Paramedic

Greg Friese issued a challenge of sorts to some bloggers the other day:

“Take Sean Eddy’s excellent series about famous people as Paramedics and let’s all do a Tim Tebow one.”

 

I imagine the idea was to see how different bloggers interpret the pop culture figure and perhaps learn more about them in the process.

So here goes:

If Tim Tebow was a Paramedic…

I would still not know who he is, nor care too much.

People get upset when he prays at the scene of a call.  That’s his right, surely, but there is a time and a place and at the scene ain’t it.

From recent accounts he would be useless at the scene of the call but wrap up the tube, the vent and the Dopamine piggyback in the time it takes to get the rig from the street to the ED entrance.  Then he’d take all the credit and point upwards.

But on the ones we lose he won’t point up.

Tim Tebow as a Paramedic would last about 3 weeks in any EMS system.  Especially when the “Roxies” get to him.  More on that soon.

Please tell me Santa brought Motorcop…

One of these:

Flashlight with video recorder AND night vision?  Hells yes, MC needs this!