It’s been a while …

… but I’m back in the Writing Saddle again. 

Tanned.  Fit. Rested.  And ready to go.

Public Education

“Free rides to the hospital, 24 hours a day”  I added that top banner earlier today after realizing that slogan was probably a more accurate advertising message about what we do than “Emergency Medical Service”, which is prominently marked in Scotchlite lettering on both sides of every ambulance in our fleet. 

I’ve been doing this job long enough to remember when we had to beg people to call us.  As a probationary EMT back in the very early 80s, our squads routinely visited school children, Kiwanis Club meetings, the staff at all the local nursing homes, et al, handing out brochures that detailed what a paramedic could do (mainly cardiac intervention back in those days) and why it was safer to call us rather than wait for the doctor or travel in a private auto.  We were still overcoming the image of funeral home attendants with little or no medical training, and we wanted to reassure our fellow citizens (especially the elderly) that this newfangled ambulance service with EMTs and Paramedics was much more than a quick ride to the hospital.

How times have changed.  EMS switchboards are flooded with calls for patients with non-emergent, and to be brutally honest, *silly* chief complaints like sunburned feet or runny nose and chest congestion on a 15 year old.  Many times, there are multiple cars in the driveway (and a licensed driver or three on hand) and the patient is not only ambulatory, but they insist on getting the mail first, then feeding the dog, and then finishing their cigarette prior to being jetted away in the Orange Taxi, hopefully to bypass that pesky traige desk and waiting room in the Emergency Department.  And I still find it amazing that patients who say they have no other way to the hospital always have a way back home. 

So what went wrong?  You could point fingers in a hall of mirrors and always find the right answer on this one.  Society has changed.  Tort liability has changed.  Medicine has changed.  Personal responsibility has changed.  And EMS, rather than take a proactive stance against system abuse, has taken the path of least resistance and seems to say “Thank you, Sir. May I have another?” every time they get hit with another non-emergent ambulance call.  Let me spell it out:  If you respond to an EMS call and the assessment shows a first degree burn on the top of the foot (an actual EMS call I had last summer), and if you load ‘em up and go to the emergency room as requested, and if you never open your mouth and tell the patient and family this is an inappropriate use of a finite public resource, then you are validating and approving the next non-emergent call and further abuse of the system. 

How are patients and their families supposed to know they shouldn’t be calling 9-1-1 for minor medical problems if no one ever tells them?

I realize this is easier said than done.  Employers have policies and procedures, medical protocols and SOGs are in place that can’t be violated without you being disciplined, and the never-ending game of “what if” starts, forcing the EMS provider to thnk about things like ‘what if that sunburned foot becomes necrotic and what if the person loses several toes then what if they throw an embolus that causes cardiac arrest and … and …  AND THE PATIENT DIES and we all get sued … then what??????’

To be fair, you can’t let someone slip through the cracks.  EMS is here to help people, and I don’t want the elderly woman or man laying in bed at home, getting sicker and sicker, but afraid to call 9-1-1 because they don’t want to bother us.  I know some minor symptoms can mask a more serious medical problem.  I know today’s legal environment is treacherous for all medical professionals.  And I know we have some EMS providers that would abuse any privledge to determine a no-transport because they’re worthless and burnt out and lazy.

It may take decades to completely address the abuses we have now, but we need to start somewhere.  I propose a simple public education program that will work similarly to what we did in the early days of EMS.  A national theme and a campaign is great, but our message needs local distribution by trusted EMTs and paramedics in the communities they serve.  I think a short discussion about the most flagrant cases of system abuse is in order, and the costs of handling those abuses while trying to maintain respectable response times for true emergencies should be mentioned.  In today’s rough economic climate, we simply can’t afford to transport obviously non-emergent calls and keep enough squads and first responders on the road to save someone’s life when a more serious call comes in.  “EMS is for emergencies only” or something similar could be the theme.  I’m not looking for a total fix, but if we could stop some of the siller stuff and call public attention to the problem, that would be a start.

More later.

The Project

If you live in a cave somewhere, or you work a lot of overtime and don’t get out often, then you’re probably not familiar with “The Project”.  Two EMS bloggers, one from America (San Francisco, to be more precise) and the other from Great Britian managed to connect here in cyberspace and began comparing notes on the differences between America’s fire-based, public safety model of EMS delivery vs. Britian’s more socialized but independent system run through the National Health Service and integrated with other health delivery programs available there.  After an online buildup of questions and comments lasting several months, Justin and Mark (the two bloggers) were able to arrange a week or so riding with the other on their ambulance, and both men have written extensively about the similarities and differences between the two systems in a professional, educated, and respectful way.

This has been a fascinating project to follow.  It is usually one of my first reads every morning and our EMS crews have often discussed the previous day’s blog postings while we are at work.  “The Project” has received international attention through JEMS Magazine and other media outlets, and, if the right people take the time to listen and learn,  the things we have discovered may significantly impact the future of Emergency Medical Services here in the United States.

http://www.thehappymedic.com and http://www.999medic.com are the individual blogs to follow.  Bookmark both and visit them often.  It’s been exciting to watch this all play out, and it just goes to show how great things can happen when the best and brightest from all around the EMS world work together to make something happen.

Ramblings

I’m not sure why I started blogging.  Maybe it was the encouragement I received from reading other EMS and public safety blogs, knowing there were other tortured souls out there who loved this job in a bittersweet way, and feeling like there were storms brewing inside me that needed an avenue of release.

I have no idea where to start this blog and no idea about where it’ll go.  I am a complex person who feels things on a number of levels and can see one situation five different ways.  I’m a lifer, too.  As I approach my 50th birthday, I realize I have been doing some kind of public safety work since age 16.  I’ve been an EMT since age 19 and a paramedic since age 22.  I’m currently a fulltime paramedic and front-line supervisor with a third service government agency in a  mostly rural setting.  We are busy.  24 hour shifts aren’t nearly as fun as they were back in 1985 when I started doing this gig fulltime.  There are lots of sleepless nights and a recovery period that can last a few hours of my next day off up to a week of convoluted sleep and always feeling tired, as my body screams out for some kind of normalcy for the Circadian clock.

But I love this job, and many times I cannot imagine doing anything else.  I love taking care of and helping people who truly need my services.  I think I have a natural gift of warmth and compassion that occasionally peeps its head through the clouds of my weariness and stress and occasional exasperation with the not-so-nice side of this job.  I’m comfortable with my skills, although I tend to be more traditional and old fashioned with my approach to assessment and patient care than one of the hot-shot kids fresh out of the Medic Factory.  With increasing age, I’m getting a genuine, patented Missouri Attitude.  SHOW ME.  Don’t tell me how great EMS life would be if only we’d buy some new piece of equipment or get some new drug on the truck.  SHOW ME how it will work better and PROVE TO ME it’s better than what we have now.  I just might buy in to the plan if you can do that.  You see, everything that glitters is not gold.

I am becoming my grandfather.

Hello

It’s a constant fight in my head between the questions of why I ever started doing EMS in the first place and why would I ever want to do anything else.