I was going to write a post about the new bloggers I met at the NRA Meetings. Those would be new to me bloggers who I am adding to the blog roll. Then I clicked on an email from EMS1.com which had the following story.

Shoals EMTs required to wear helmets

Which included this quote,

“The back of an ambulance is an unsafe place. We’re driving high rates of speed through red lights and stop signs,” said Gibson. “Hopefully they stop and they should, but things happen and sometimes people don’t see us and we get hit.”

Here’s a better solution Mr. Gibson. Have your crews stop driving at high rates of speed through red lights and stop signs. Have them come to a complete stop at red lights and stop signs and then proceed with caution when it is safe to do so. The few seconds that doing this will add to every response are are going to be more than offset by the increased safety not only to your crews, but to the public in general and your patients.

Are you going to require your patients to wear helmets when the are in the back of the ambulance?

That’s a rhetorical question, I know the answer.

I’m not against EMS systems issuing helmets to their employees, not at all. In fact, it’s long overdue. What’s not overdue are stupid one size fits none policies about wearing a helmet all the time while working.

“It’s a professionalism too. We feel more professional, nice uniform, nice helmets,” Hargett said. “We feel more comfortable, more involved, more professional – like the police or the fire department.”

Professionalism? I think that most patients are going to snicker at a paramedic coming into their house wearing a helmet, not consider them professionals. While fire fighters wear helmets when indicated, they don’t (at least in my area) wear them on routine medical calls. The police have helmets, but they too don’t wear them except when circumstances dictate.

Oh, if Gibson is concerned about the safety of his crews, maybe he could buy ambulances with some space in the patient module instead of cramped flower delivery trucks with stretchers.

Ambulance officials said the use of helmets is a growing trend across the country.

 

While this may be true, that doesn’t mean that EMTs and medics are increasingly wearing them all the time while working. It just means that finally ambulance services that aren’t affiliated with fire departments are providing helmets for use when needed, not wearing all the time. Maybe Gibson just wants to make sure he gets his money’s worth out of the purchase.

For context, I urge my readers to go to Ambulance Driver and read this post.

Now maybe you’ll understand that this is not a joke.

Did you know that clean hospital sheets have an intrinsic Oxygen saturation of 86%? How do I know that you ask?

I know it because of the countless times I’ve responded to “low oxygen saturation” calls (courtesy of one of the private ambulance companies that uses 9-1-1  to bolster their after hours staffing) at allegedly skilled nursing facilities only to find the probe firmly clipped to the sheet and not the patient.

Amazingly, when we put the probe, you know, actually on the patients finger we get a reading in the normal range, accompanied by a “What the hell are you people doing waking me up at 0330 in the morning.” look from the poor patient. Only to have the barely speaks English employee insist that the doctor wants us to take the patient to the hospital.

I think they teach them that at Dumb as a Stump School of Nursing and Blank Stares.

Speaking of (un)skilled (no)nursing facilities, a couple of years ago we responded to a notoriously bad one courtesy of the aforementioned private ambulance company for a cardiac arrest. Sure enough, the patient was in cardiac arrest. We attempted resuscitation per our protocol and then terminated our attempt. Also following our protocol. Since we don’t transport deceased patients, we cleaned up nicely and got ready to leave. The supervisor, or whatever he was, came storming in and his broken English told us that the patient’s doctor wanted the patient transported to the hospital. Tough shit I told him, only I was much nicer in my wording but the message was clear.

“We don’t work for you doctor, we have one of our own and she says to terminate resuscitation and leave.” Which we did.

What I really wanted to do was put on my best Slim Pickens accent and say, “Piss on you, I’m working for Dr Smith.”, but for once in my career I bit my tongue and just smiled at the man.

Shit like this is why I tell people that I can’t write a book about my experiences in EMS because no one would believe I didn’t make it usp.

All of which is why I’m always nice to my children, especially my daughter. As she’s told me, she’s the one that’s going to pick out which nursing home I go to.

One of the perks of my new job is that I get to look at the portfolios that the students have to keep while they are in their clinical and field rotations. In addition to correcting any paperwork problems that they have, I get to review all of their documentation. They have to have X amount of 12 Lead interpretations and so I get to look at a lot of 12 Leads. Sometimes, we’ll discuss them, especially if I think that the interpretation is wrong. I don’t do that to prove how smart I am, I do it so that the student will neither become dependent on the all to often incorrect computer interpretation, or blindly accept what a nurse or doctor tells them.

A couple of weeks ago, I was prepping a student to move on to his field rotations and the following ECG was in his portfolio. We were a little bit rushed, so I didn’t get a chance to take a good long look at it. When I did look at it, I wasn’t convinced that the interpretation was correct. I’m still not convinced, so I thought I’d toss it out to my 12 Lead guru readers and get your thoughts.  I have my opinion, but don’t want to share that until I read a few comments.

The downside of getting these strips is that they are generally not in color, so they are a bit hard on my eyes and I’ll presume yours.

A little bit of follow up to yesterday’s story about the paramedic arrested in by an NYPD officer.

EMT, cop scuffle in ambulance

Haley was about to give her an electrocardiogram when the unidentified cop asked her for information.

Haley then told the officer to leave and to shut the ambulance door because the unidentified woman’s breasts would be exposed during the procedure, the sources said.

This makes sense. Police officer or not, he doesn’t need to be in the back of the ambulance while the patient is being partially disrobed. I understand that the officer probably has to write an “aided” report as they call it in New York. Still, his report is way behind actually treating the patient on the “to do” list.

When the cop refused, Haley allegedly shoved him and the two got into an argument, with the cop shouting, “Get your hands off me!” and each calling for a supervisor, the sources said.

I can think of about half a dozen comments to describe this activity, but they wouldn’t be appropriate, so I’ll just stick with inappropriate. Or maybe stupid. One sort of subtle way to handle this, and something I’ve done when I’ve had unnecessary people in the back of the ambulance, is to leave. Telling who ever is driving the ambulance to jump up front and drive and advising anyone standing in the back of the ambulance that we’re about to leave usually cleared the ambulance right away. It even worked to get noisy and useless supervisors to hop out. Grappling with a police officer, no matter what your intent, is probably not a good idea.

As tempting as it might be to file this under the Sumdoap category, I’ll leave it as is.

And now you know… the rest of the story.

Good day.

At least I don’t think it is.

Paramedic Arrested After Asking Cop to Leave Ambulance, NYPD Says

BOERUM HILL — A paramedic tending to a 59-year-old woman suffering a heart attack in a Brooklyn subway station was arrested after getting into a dispute with an on-duty police officer who followed the victim into an ambulance Monday morning, Police Commissioner Ray Kelly said.

I’m sure that he conversation was very interesting. And spirited.

“The [paramedic] wanted the police officer to leave,” Kelly said. “The police officer didn’t want to leave.”

This would be what we could call the “Readers Digest Version”. I’m sure that conversation was probably a bit more detailed than that. I understand that the officer has to do some sort of report on this incident. I’m also reasonably sure that the paramedics are going to have to do some amount of disrobing of the patient to do their exam and the 12 Lead ECG. At least I’d hope that they were planning to do a 12 Lead. Both people had a legitimate interest and reason for being there. That being said, the officer has no more right to be in the back of the ambulance at that second than any other non medical person on scene. Any information he needs can wait or he can follow the ambulance to the hospital and get it there.

The medic was then arrested by the officer for “obstructing government administration.”

Well then. It’s rather obvious that the officer didn’t have any pressing business in the back of the ambulance. Come to think of it, wasn’t he sort of obstructing government administration by arresting the paramedic?

He was taken to a nearby precinct where the charges were later dropped, Kelly said.  

No kidding. That must have been an interesting conversation. Although it’s likely that the Desk Sergeant or whatever they call it in New York City, did most of the talking.

I’m not a lawyer, I don’t play one on TV, nor did I sleep at a Holiday Inn Express last night. Still, I actually went to a police academy of sorts and several refresher courses at one time. One of the things I learned about arresting people was that once they are arrested, they stay arrested until they appear before a judge or magistrate. In other words, the police have the power to arrest people, but they can’t “unarrest” them. Once the cuffs go on, the person has to be booked and on the booking sheet, or whatever they call it in NYC, there is a space for the charge or charges upon which they were arrested. Once that all starts, it is not supposed to be stopped. So doing risks the police officer and everyone in his chain of command right up to the Mayor being sued for false arrest.

Of course the work around for that is convincing, or if you prefer, coercing the person being arrested into signing a waiver of his rights in exchange for signing.

If this story doesn’t die because nothing further comes of it, it could be very, very interesting for people at the NYPD. If nothing else the officer should be sent for further training regarding inter agency cooperation and not looking like a fool on April Fools Day.

This article is about ten years old, but it’s still relevant.

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Abstract

As the saying goes, read the whole thing.

Keep in mind that the British Medical Journal is a real publication and a serious one at that. It’s not the Journal of Iatrogenic Medicine*, so you can trust it for the most part. A friend of mine who reads the BMJ regularly assures me that this article was in fact peer reviewed before it was published. The references are real, I clicked on them to be certain. Another friend who spends a lot of time teaching fellows who jump out of perfectly good aircraft all too often, tells me that he uses this in his classes. The guys get a kick out of it when they are discussing EBM.

A call to (broken) arms

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

The authors point is valid. Not everything we do in medicine or EMS has a lot of science behind it. Sometimes we have good evidence, but sometimes we don’t have good evidence and yet a procedure or technique seems to work.

I can’t wait for Rogue Medics 73 part, multicolor, 17 font, rebuttal.

I  really ,really, really, need to Trade Mark that or something before someone uses the name.

Most of my TV watching is confined to older shows. I rarely watch anything on network TV with one or two exceptions.

As a result when I’m working out in my home I generally search through the On Demand shows for something watchable.

As it happened about a week or so ago I found a show on the National Geographic Channel called “Inside Combat Rescue”. Intriguing title, I thought so I clicked on it and found out that it’s a six part documentary that follows a team of USAF Pararescue Jumpers (PJs) on deployment in Afghanistan.

I’ve known a couple of PJs over the years and they have been top notch guys. They provide a vital service and yet rarely get public recognition compared to other special forces such as the Army Rangers or SEALS.

Their training and capabilities are similar to the SEALs (I know someone will comment on that) with a big difference being that every PJ is a paramedic. Which is why I though the show might be pretty interesting.

I’ve watched three of the six shows so far and it’s pretty good. Not a lot of medical calls, but a whole lot of trauma if that’s your thing.

One thing I will warn you about. The narrator makes frequent reference to the “Golden Hour”. I know that the very term raises Rogue Medic and others blood pressure to stroke inducing levels, which is why I mention. I will note that the PJs themselves never use the term, just the narrator. They do, however, understand the underlying concept, probably better than most civilian paramedics. Which is that the sooner a trauma patient is in the OR, the better off they generally end up.

As they say on TV, “Check Your Local Listings” and give it a watch.

Inspector general launches probe of DC fire department staffing

WASHINGTON - The D.C. inspector general has begun an investigation into the D.C. fire department’s staffing levels to see if it can support around the clock emergency response.

The probe was launched in late January after a hundred firefighters called in sick on New Year’s Eve.

That is some work ethic right there folks. Not a good one though. Part of being a fire fighter, paramedic, EMT, or police officer is understanding that while your family and friends are out celebrating on the big holidays, you might have to suck it up and go to work. It’s part of the package and I missed a lot of good times because I had to be at work.

FOX 5 has also obtained a document showing the fire department is looking for 20 of its ambulances.

In an email, sent by Deputy Chief John Donnelly to as many as seven other officials in the department, asks for help in locating the rigs.

Hint: It’s big. It’s red and white. It has blinky lights on it. Oh, and it will say “District of Columbia”, “Fire and EMS Unit”, and might even have the part of the District it allegedly serves written on it. That’s if it actually exists and is not a Potemkin ambulance. In which case it won’t actually be an ambulance.

Donnelly is conducting an audit of the department’s entire fleet after FOX 5 reported last Wednesday the number of trucks and pumpers given to the city council were false, and that as many as six pumpers and two ladder trucks claimed as reserves in the city are no longer in the fleet and have actually been sold. Still, others were unaccounted for.

I think that this calls for another blue ribbon commission to study ways to improve the service and make recommendations that the city can ignore. After all, there are phony baloney jobs to save!