Social Media Assisted Career Suicide Syndrome is a phrase created by Dave Statter of Statter911. That term goes under the “I wish I thought of it first” file. At least I wish I put it on line first, because I came up with a similar “Social Media Assisted Career Syndrome” term sometime in the past, but still probably not before Dave.
By the way, if you’re interested in fire stuff, or EMS stuff related to fire stuff, Dave’s blog is a good place to go.
As any of you who have read my blog for a while know, whenever there is some sort of bad thing in EMS, I always want to find out what the real story is before making judgement. From a long career in EMS, I know that initial reports and media stories are often inaccurate. At the least inaccurate, sometimes deliberately slanted.
Having seen EMS management take a cynical attitude of “We’ll fire them first and then do an investigation after.” approach I am at the least skeptical.
I could regal you with stories of people I worked with who were disciplined first and then had their salary and status restored later because of sloppy work by management.
Which brings me to today’s blog post.
Two years ago an East Tennessee paramedic bragged on Facebook that he intentionally drilled into a patient’s bone without anesthesia, then allegedly told other first responders this was a “teachable moment” on how to deal with troublesome patients.
The paramedic also instructed another first responder to insert a plastic breathing tube deep into the same patient’s nose but told her to coat the tube with alcohol-based hand sanitizer instead of lubricant.
“If you should ever find yourself drunk in my ambulance, do not become belligerent,” the paramedic wrote on Facebook during the incident. “I have a drill and I ain’t scared for a second to use it.”
The State of Tennessee has already had a hearing and revoked his paramedic certification, so there has been an extensive hearing on the matter.
Just in these three paragraphs, Stokes indicts himself for being a Certified EMS Dumbass.
First Stokes used a Intraosseous (IO) drill to administer Narcan. I have never, ever, heard of that being done that way. Which doesn’t mean that it hasn’t or can’t be done. It’s just a stupid thing to do.
Here is an EMS “Top Tip”. Narcan can be administered in several ways, including IO, but in my experience the least invasive way is the best. Nasal administration is the least invasive, but it’s onset of action is a bit slow. IV or IO is the most invasive. The problem with that, from a patient management standpoint is that patients wake up fast and they wake up mad. That’s when they want to fight because you, the life saving paramedic, have ruined their high. Forget that you also probably saved their life, you now have a made patient with an IV in their arm.
Things can, as the saying goes, go sideways in a hurray. In cases like that, paramedics and patients can get hurt.
If you do an IO insertion, the very first thing that you do is then inject Lidocaine through it. Why you may ask? Because while the actual insertion doesn’t hurt more than an IV, once the paramedic starts to push fluid or medications through the IO, the pain is excruciating. When we first started using IO for treating patients, we didn’t have a protocol for Lidocaine. One day we had a patient who was unconscious and had no IV access. So, my partner whipped out our IO “gun” and drilled into the patient’s leg. No reaction. We then hooked up an IV bag full of “normal saline” and started to run some in. THAT woke the patient up and he was not very happy.
After that, we got a new protocol which included Lidocaine for all patients getting IO insertions, unless they were in cardiac arrest.
So, right there we have two strikes on Mr. Stokes. Okay, a strike and a half because per protocol IO Narcan is an appropriate route of administration. It’s just not too smart.
Then we have this,
After the bone injection, Stokes told the other AEMT to insert the breathing tube, known as a nasopharyngeal airway, which extends into a person’s nose and reaches into the back of their throat.
The AEMT initially questioned this decision, insisting that the patient “had a good airway,” but Stokes told her “that he would explain later,” according to state records. The AEMT then began to put lubricant on the nasal tube, but Stokes “stopped her and instructed her to use hand sanitizer” instead.
Once the tube had been coated in hand sanitizer and inserted into the patient’s nose, Stokes removed it — revealing it was not necessary — and told the AEMT this had been a “teachable moment on how to deal with belligerent patients,” according to state records.
I find myself in the uncomfortable position of defending one part of this, but only one part. I don’t think it was unreasonable to insert a nasopharyngeal airway (NPA) into this patient. It’s a non invasive airway, used by EMS providers at all levels. I’ve used one, although it wasn’t my preferred BLS level airway device. Perfectly acceptable.
The part that isn’t acceptable is using hand sanitizer instead of the proper lubricant. Which is more slippery than hand sanitizer and doesn’t have alcohol.
Stokes’ excuse is that he was taught that by an “army surgeon” while he was working in Afghanistan. I’ve been fortunate to sit in on some military medical training. It’s far different in some case than what we do (and can do) in civilian medicine. I can, sort of, see where someone might have to use a “field expedient” lubricant under combat circumstances.
Such is, however, not the case in the back of an ambulance in Chattanooga, TN, even with that city’s problem with gang violence.
At best, I *might* tell someone about that sort of thing after the call was over. I certainly wouldn’t advocate doing that sort of thing.
Then there is this,
State records say Stokes then began to conduct a “drill,” quizzing the AEMTs on what could be wrong with the patient. The AEMTs responded by saying he was suffering from an “obvious overdose” and that there was no time to “conduct class” when they needed to hurry to the hospital.
I hate when I read or hear a media report that “paramedics rushed the victim to the hospital.” The inference of course is that is all that was done for the patient. Toss in the back of the ambulance and then drive like The Three Stooges to a hospital.
Opioid overdoses are pretty routine to treat. So much so that some families of addicts have Narcan kits in case their family member should overdose.
That being said, the time to do some “drilling” of students is before or after a call, not during. After the call, while at the hospital or elsewhere, you go over the case, ask questions, solicit answers and do your teaching. Not during the call.
Finally there is this,
State officials interpreted the letter as Stokes encouraging a full revocation of his license, but Stokes now argues a “null and void” finding is a lesser discipline than a revocation, which he says will prevent him from pursuing a career as a nurse.
A nurse? I rather doubt that the nursing profession wants or needs Mr. Stokes. He exhibited poor judgment in the first place by doing the things of which he was accused. He compounded his error by posting about it on Facebook. Then, he didn’t attend his hearing. I don’t know if he had an attorney or not, but if I had to guess, I’d say no.
Almost as dumb as the foregoing, he then gave an interview to the media. That didn’t help, not one bit.
As always, if Mr. Stokes or anyone comes forward to show me that the course of action he took that day was correct and appropriate, I’ll delete this post and put up another one announcing his vindication.