This post arose from a discussion I had with a colleague. I was being singled out, and essentially berated, for terminating resuscitation efforts on an 87 year old man who died while his wife was in church. His wife agreed, as did the physician on the phone. I was at the hospital after obtaining the physician's order signature to terminate resuscitation.
My colleague stated "people aren't dead until they are in a hospital, and a doctor says they are dead."
My colleague is an idiot, and thankfully, does not wear the same patch as I do, and does not serve in a primary caregiver role.
He is of the thinking that there is "something that they can do" that we can't. Like open cardiac massage on a 60-something year old patient? Hardly. This job is nothing like television makes it out to be. (Did anyone ever get pooped on during an episode of E.R.?)
Death is the most unavoidable part of life. From the moment we are born, or from the moment we are conceived, depending on your political leanings, we are destined to die.
The CDC reported 2,436,652 deaths in 2008. Only 170,314 of those were attributed to "Accidents (unintentional injuries) Intentional self-harm (suicide) and Assault (Homicide). We are ten times more likely to die from heart disease or cancer. Interestingly enough, Blacks have a much higher infant mortality rate, more than twice that of whites.
EMS responds every day to people not breathing, and without a pulse. Out-of-hospital cardiac arrest has, for lack of a better term, a terrible prognosis. On the high end of the prognosis, 8% of patients in prehospital cardiac arrest survive to discharge, while the low end cites a percentage of 2. The prognosis for in-hospital cardiac arrests are much higher, but still gravely low. One could argue for the importance of early defibrillation, and the access to healthcare providers in the hospital. (Even the janitors at my local hospital have CPR certification.)
Patients presenting in the prehospital system with either ventricular fibrillation or pulseless ventricular tachycardia have a 10-15 times greater chance of survival.
These are statistics from one source, the CDC. I doubt you would find a prehospital provider that would argue with these statistics, however. Personally, in my years of experience, I have seen a total of 2 patients who presented initially in ventricular fibrillation survive to hospital discharge, 2 patients who presented in pulseless ventricular tachycardia, and 0 who presented in a pulseless electrical activity (PEA, EMD, Ventricular escape, whatever...) survive past the emergency room. I could not tell you how many cardiac arrest calls I have run, but I would venture to say it is well over 200, which would be in line with the (admittedly doubtful) Wikipedia article.
Transporting patients without perfusing rhythms is fruitless. It does nothing but provide false hope for family members, increase the risks of accident enroute to the hospital, and increase the opportunity for injury to a provider in the back of the ambulance.
As mentioned by a person much smarter than I, "asystole is not a workable rhythm, it is a confirmation of death."
Granted, there are times to perform CPR and transport these patients to a hospital. The elderly person who collapses at the Sunday buffet is a good example. It simply wouldn't be prudent to leave a dead body covered by a sheet in front of the salad line.
There are also times in which transport is not warranted. The person in cardiac arrest, with a patent airway and intravenous access, with no signs of life, and no response to pharmacological intervention should, with family concurrence, have efforts terminated on scene.
Medical directors who insist their medics continue to transport dead people emergency to the closest hospital do nothing to advance this field. Medics who are not ready to challenge those medical directors are doing nothing for the field either.
We, as a whole, should stop transporting dead people to the hospital, only for a physician to confirm what we already know.
My colleague is still an idiot.
Showing posts with label Co-workers. Show all posts
Showing posts with label Co-workers. Show all posts
Saturday, September 17, 2011
Friday, September 16, 2011
Easy? Sure.
"This job is easy." Said the man with his paramedic patch that had been sewn on less than 12 months ago. "I mean, why do people think this job is so complicated?"
"Because it is complicated, that's why" came the reply with the more seasoned, yet not a veteran, paramedic.
"No, it's not. This is easy. I can't believe they pay me to do this job, it's so simple."
"How much time a week do you spend studying?"
"Why would I need to study? I already finished paramedic school and passed National Registry."
"Exactly."
It's scary to think we can trust lives with some of these people.
"Because it is complicated, that's why" came the reply with the more seasoned, yet not a veteran, paramedic.
"No, it's not. This is easy. I can't believe they pay me to do this job, it's so simple."
"How much time a week do you spend studying?"
"Why would I need to study? I already finished paramedic school and passed National Registry."
"Exactly."
It's scary to think we can trust lives with some of these people.
Wednesday, September 14, 2011
So much for social networking.
This social networking thing has gotten out of hand. I have previously commented on one of them, here. I have become quite disappointed in the childish behavior exhibited by my coworkers and colleagues. I seriously thought higher of people than I should have.
One would think, with the seriousness of this profession, there would be a modicum of adult behavior, but no, some of us have decided to resort to name-calling and trash-talking. This is supposed to be a field of adults, but we too often stoop to a high-school level with our behavior. I have been guilty of it as well. But not any more.
So I cleaned up my Facebook friends. No longer will I be "friends" with my coworkers, because, frankly, my coworkers aren't my "friends." They are my "coworkers." I may make a CCC Facebook page later, in an effort to expand my readership, but we will have to see.
I know that several of my readers are my friends on Facebook, and I frankly trust them to maintain my anonymity, and to behave like the adults that I know they are. So, if you are here, and you are there, then I consider you a friend, and I am glad to have you in my life.
One would think, with the seriousness of this profession, there would be a modicum of adult behavior, but no, some of us have decided to resort to name-calling and trash-talking. This is supposed to be a field of adults, but we too often stoop to a high-school level with our behavior. I have been guilty of it as well. But not any more.
So I cleaned up my Facebook friends. No longer will I be "friends" with my coworkers, because, frankly, my coworkers aren't my "friends." They are my "coworkers." I may make a CCC Facebook page later, in an effort to expand my readership, but we will have to see.
I know that several of my readers are my friends on Facebook, and I frankly trust them to maintain my anonymity, and to behave like the adults that I know they are. So, if you are here, and you are there, then I consider you a friend, and I am glad to have you in my life.
Thursday, September 8, 2011
On criticism
Recently, a co-worker of mine responded to an accident with possible injuries, which blossomed into an MCI with 4 patients, with 2 possibly critical. While I wasn't there, and won't comment on the assessment or treatment of any of the patients, it's what happened after the call which is interesting.
One of the supposed (and I use the word "supposed" because there seems to be some debate about the actual status of the patient) critical patients, was a young female adult, with left-sided abdominal pain, and a mechanism which lead to a high index of suspicion for a bleeding spleen.
The first medic on scene reportedly (by all parties involved) had two patients immobilized onto long backboards when the second crew arrived. The point of contention seems to be what happened next.
Instead of the second unit leaving rapidly, the crew members elected to remain on scene for (at least) an additional 8 minutes prior to departing to the hospital. They performed a thorough assessment, and attempted IV access twice, without success. The medic member of the crew did not suspect a lacerated or bleeding spleen. While I do not know that particular medic very well, there is nothing I have seen for me to even remotely question his assessments.
The first medic then subsequently immobilized two more patients, and departed for the hospital, arriving prior to the second unit. When questioned about what "took so long" to get to the hospital, the EMT member of the second crew stated "we were doing a thorough assessment and trying for IVs."
Instead of objectively stating the findings of his detailed assessment, the EMT with 18 months of experience told the medic with 18 years to "mind your own business."
One caveat here. I fully believe in the assessment powers of my coworkers. I have worked with many of them, and would freely put my life, or the life of my loved ones in their hands. I always try to avoid criticizing the treatments or interventions performed by others.
About 12 hours later, the EMT decided to insinuate on a social networking site that the first medic on scene was behaving in a "the sky is falling" manner. This led to a long thread of comments, from no fewer than 6 people, on the merits of the call. None of the interventions were called into question. What was called into question was the professionalism of gossip.
I could go on, but won't. Mostly because this is not the place for such a discussion, and partly out of respect to all parties involved, in an effort to minimize the gossip and negative comments.
What I have learned from events surrounding this call:
1. When approached by a colleague, regardless of certification level, or experience, it's always best to listen with objective ears, in an effort to learn something.
2. Discussing a coworker behind their back, whether good, or bad, will always result in that employee finding out what you have said. This is a small community, as referenced in my state, which has been licensing paramedics for 35+ years, with only 12,000 or so reaching certification, with a population approaching 10 million.
3. If you are going to talk about a coworker behind their back, there must be a willingness to accept the ramifications of your actions.
4. Everyone respects the patch, and everyone needs to respect the person wearing the patch.
5. Social networking sites may not be the best place for work-related discussions.
6. Just because it says "Paramedic" on my patch doesn't mean that I can't learn from an EMT.
I have not lost any respect for either one of my coworkers, but have learned an invaluable lesson regarding my professional relationships.
One of the supposed (and I use the word "supposed" because there seems to be some debate about the actual status of the patient) critical patients, was a young female adult, with left-sided abdominal pain, and a mechanism which lead to a high index of suspicion for a bleeding spleen.
The first medic on scene reportedly (by all parties involved) had two patients immobilized onto long backboards when the second crew arrived. The point of contention seems to be what happened next.
Instead of the second unit leaving rapidly, the crew members elected to remain on scene for (at least) an additional 8 minutes prior to departing to the hospital. They performed a thorough assessment, and attempted IV access twice, without success. The medic member of the crew did not suspect a lacerated or bleeding spleen. While I do not know that particular medic very well, there is nothing I have seen for me to even remotely question his assessments.
The first medic then subsequently immobilized two more patients, and departed for the hospital, arriving prior to the second unit. When questioned about what "took so long" to get to the hospital, the EMT member of the second crew stated "we were doing a thorough assessment and trying for IVs."
Instead of objectively stating the findings of his detailed assessment, the EMT with 18 months of experience told the medic with 18 years to "mind your own business."
One caveat here. I fully believe in the assessment powers of my coworkers. I have worked with many of them, and would freely put my life, or the life of my loved ones in their hands. I always try to avoid criticizing the treatments or interventions performed by others.
About 12 hours later, the EMT decided to insinuate on a social networking site that the first medic on scene was behaving in a "the sky is falling" manner. This led to a long thread of comments, from no fewer than 6 people, on the merits of the call. None of the interventions were called into question. What was called into question was the professionalism of gossip.
I could go on, but won't. Mostly because this is not the place for such a discussion, and partly out of respect to all parties involved, in an effort to minimize the gossip and negative comments.
What I have learned from events surrounding this call:
1. When approached by a colleague, regardless of certification level, or experience, it's always best to listen with objective ears, in an effort to learn something.
2. Discussing a coworker behind their back, whether good, or bad, will always result in that employee finding out what you have said. This is a small community, as referenced in my state, which has been licensing paramedics for 35+ years, with only 12,000 or so reaching certification, with a population approaching 10 million.
3. If you are going to talk about a coworker behind their back, there must be a willingness to accept the ramifications of your actions.
4. Everyone respects the patch, and everyone needs to respect the person wearing the patch.
5. Social networking sites may not be the best place for work-related discussions.
6. Just because it says "Paramedic" on my patch doesn't mean that I can't learn from an EMT.
I have not lost any respect for either one of my coworkers, but have learned an invaluable lesson regarding my professional relationships.
Baba O'Riley
Riding through the city, with my iPod playing, and The Who comes on. I didn't plan on The Who, as I normally have to be in the "mood" for their music. I won't argue their artistic talents with anyone, just not my normal taste.
Baba O'Riley.
Or, as the uninitiated call it, "Teenage Wasteland."
This song reminds me of one of my favorite partners, who, because of this song, I now refer to as "Sally." I have been graced with some of the best partners anyone could ever have asked for in my career, and was deserving of very few of them. We only spent 9 months together, until the Cajun took my place. I wish it could have been longer.
Our first shift together was at a strange transition. I had just finished three months of critical care training, third rides and monumental amounts of studying, along with a change in shifts from a day truck, back to nights.
"Hi. Are you going to be my new partner?"
"Hurrrumphff. I don't know."
"Well, I'm excited."
"Mmmmmmhmmmm."
Fifteen minutes of silence as we drove to our posting location for the evening in a fine, upstanding neighborhood full of food stamps and illegal aliens.
"Hey, do you want some Gouda?"
"Some what?"
"Gouda. You know, cheese. And crackers?"
"Seriously?" (I mean, who seriously brings Gouda and crackers to work on an ambulance?)
"Sure. Thanks."
We turned out to work fantastically together. We shared lots in common. We both have a child around the same age. We shared many nights of Handel on the Law podcasts, and yelling at dispatchers. We shared watermelon gum and hunts for clean bathrooms. She reaffirmed my love for iced coffee. We lived close to each other. She introduced me to some interesting and new beer, and I introduced her to limoncello. (Off duty, of course.) We shared a mutual hatred for people who abuse the 911 system, and the nurses who were of a below-average intellect who we turned over said people to. We shared many evenings watching the patrons of the local immigrant club, and enjoyed the transvestite Thursdays. And she brought good food to work, and always shared.
She told me the stories of moving to the west coast for the forests and hiking. And how she had to move back because she ran out of money. She is, and was, the ideal partner. I look forward to the chance meetings we have, as we now work opposite rotations, she at night, and me during the day. I like hearing her call me "Big Daddy." And I miss working with her.
"Sally take my hand. We'll travel south cross land."
The Cajun had better take care of her.
Baba O'Riley.
Or, as the uninitiated call it, "Teenage Wasteland."
This song reminds me of one of my favorite partners, who, because of this song, I now refer to as "Sally." I have been graced with some of the best partners anyone could ever have asked for in my career, and was deserving of very few of them. We only spent 9 months together, until the Cajun took my place. I wish it could have been longer.
Our first shift together was at a strange transition. I had just finished three months of critical care training, third rides and monumental amounts of studying, along with a change in shifts from a day truck, back to nights.
"Hi. Are you going to be my new partner?"
"Hurrrumphff. I don't know."
"Well, I'm excited."
"Mmmmmmhmmmm."
Fifteen minutes of silence as we drove to our posting location for the evening in a fine, upstanding neighborhood full of food stamps and illegal aliens.
"Hey, do you want some Gouda?"
"Some what?"
"Gouda. You know, cheese. And crackers?"
"Seriously?" (I mean, who seriously brings Gouda and crackers to work on an ambulance?)
"Sure. Thanks."
We turned out to work fantastically together. We shared lots in common. We both have a child around the same age. We shared many nights of Handel on the Law podcasts, and yelling at dispatchers. We shared watermelon gum and hunts for clean bathrooms. She reaffirmed my love for iced coffee. We lived close to each other. She introduced me to some interesting and new beer, and I introduced her to limoncello. (Off duty, of course.) We shared a mutual hatred for people who abuse the 911 system, and the nurses who were of a below-average intellect who we turned over said people to. We shared many evenings watching the patrons of the local immigrant club, and enjoyed the transvestite Thursdays. And she brought good food to work, and always shared.
She told me the stories of moving to the west coast for the forests and hiking. And how she had to move back because she ran out of money. She is, and was, the ideal partner. I look forward to the chance meetings we have, as we now work opposite rotations, she at night, and me during the day. I like hearing her call me "Big Daddy." And I miss working with her.
"Sally take my hand. We'll travel south cross land."
The Cajun had better take care of her.
Tuesday, September 6, 2011
Take the bag!
My service has a policy which requires the crew to take in the stretcher, cardiac monitor, and jump bag to every patient. I have been in the habit of taking said equipment in, even without a written policy.
While taking a cardiac monitor in to a 10 year old with a twisted ankle may be a little over kill, that's what the bosses want, so we do it. Or at least I do.
It's also a good practice. Seriously, what are you going to do for a patient who accidentally stabbed himself in the femoral artery with a turkey baster right before Thanksgiving dinner, and now there is blood squirting every which way, in the squash casserole, and all over the turkey, and the mashed potatoes, and your jump bag is 30 yards away in the ambulance? And when that call happens (and we all know it will happen, to someone), you just know there is going to be a doctor/nurse/paramedic/personal-injury lawyer watching your big, fat, screw-up.
"Ma'am, can I borrow a towel from you since I'm too lazy to bring in my equipment?"
Take in the damned bag. Take in the damned monitor. Put it on the effing stretcher so your lazy ass doesn't hurt your lazy back carrying it.
I hate lazy people.
While taking a cardiac monitor in to a 10 year old with a twisted ankle may be a little over kill, that's what the bosses want, so we do it. Or at least I do.
It's also a good practice. Seriously, what are you going to do for a patient who accidentally stabbed himself in the femoral artery with a turkey baster right before Thanksgiving dinner, and now there is blood squirting every which way, in the squash casserole, and all over the turkey, and the mashed potatoes, and your jump bag is 30 yards away in the ambulance? And when that call happens (and we all know it will happen, to someone), you just know there is going to be a doctor/nurse/paramedic/personal-injury lawyer watching your big, fat, screw-up.
"Ma'am, can I borrow a towel from you since I'm too lazy to bring in my equipment?"
Take in the damned bag. Take in the damned monitor. Put it on the effing stretcher so your lazy ass doesn't hurt your lazy back carrying it.
I hate lazy people.
Saturday, September 3, 2011
Good Luck, Cupcake
So tonight is Cupcake's first night on her own as a Paramedic. Tests have been passed, uniforms ordered and received, patches sewn on, third rides complete, and she is being "thrown to the wolves" as they say.
I had the pleasure of working with Cupcake for over a year, and we became good friends. She is one of the best partners I have ever had. She was always there to have my back, and saved me more times than I can count. She is a damned good EMT, and will be a fantastic paramedic.
Good luck, Cupcake.
I had the pleasure of working with Cupcake for over a year, and we became good friends. She is one of the best partners I have ever had. She was always there to have my back, and saved me more times than I can count. She is a damned good EMT, and will be a fantastic paramedic.
Good luck, Cupcake.
Wednesday, August 24, 2011
You can downgrade now.
A call for an infection in the leg. Bullshit.
Not only does this guy have maggots in the open wounds on both legs, but he appears to have been incontinent for several days. DAYS. Literally, covered in shit. The rest of the assessment is unremarkable, with normal vitals.
I know it stinks, and you can smell it up front, but there's not really reason for you to drive emergency to the hospital.
Not only does this guy have maggots in the open wounds on both legs, but he appears to have been incontinent for several days. DAYS. Literally, covered in shit. The rest of the assessment is unremarkable, with normal vitals.
I know it stinks, and you can smell it up front, but there's not really reason for you to drive emergency to the hospital.
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