What We Really Are

I see a lot of people in EMS who want to be heroes.  I see a lot of people in EMS who consider us part of the public safety family.  Occasionally, there’s some heroism in EMS.  And yes, in many places, EMTs and paramedics are part of the public safety team. I also hear the term life-saving bounced around.  I can count on one hand the number of EMS calls where a life was immediately saved by EMS interventions.  Lives prolonged?  Yes.  Lives made better? Yes.  Lives saved immediately?  It’s a rare occasion.

I have a real concern, though.  None of those reflect the day-to-day reality of EMS.  In my opinion, after a few years in this field in a variety of settings, we rarely get to be heroes.  In fact, if we’re at the point of heroism, something’s likely to have gone really wrong in the course of the call. What we really do is deliver unscheduled out-of-hospital medicine.  Our definition of “emergency” often varies from the patient’s definition, but the God’s honest truth is that we’re here for our patients.  Period.

Over the last couple of days, I’ve been pretty dismayed by some posts I’ve seen in EMS social media groups, whether by new EMS students or experienced providers.  I’ve seen posts advocating “punitive medicine” like ammonia caps and dropping the patient’s hand on their face to determine if the patient is “faking” a seizure.  I’ve seen other posts asking how to identify “drug seeking” patients so that a provider can hold back pain relief.  I’ve seen posts advocating that EMS providers be allowed to decide who gets to go to the emergency department. And I’ve seen posts by supposedly experienced paramedics advocating “just taking the patient to the hospital” rather than performing a complete assessment and providing treatment all because the hospital is close.

I get all of these complaints.  I really do.  We’ve all been on the shift where the calls keep coming and it seems like no one really has a supposedly legitimate emergency.  I’ve complained.  I’ve griped to my colleagues. And I try not to let it impact what I’m doing as a medic.

The reality is that we may be public safety heroes who save lives — occasionally.  But what we truly always are is professional caregivers.  Part of the obligation that you have is to suspend your judgment of the patient in order to CARE for them.  Even the most malevolent, challenging psychiatric “frequent flyer” has issues that we’re not going to be able to understand, much less fix as EMS providers.  Our duty is to assess the patient, provide care as we’re educated to, and get them to an appropriate destination to address their concerns.  When we start embracing the care aspect of the job more, we’re going to have less burnout, better outcomes, and probably some happier EMS professionals.  Until that point occurs, I’m concerned — because I’m seeing what people think is acceptable.  Ask yourself if that’s how you’d want your family treated or if you’d be proud for the local news media to showcase your last call.

It’s time for all of us in EMS to take a look in the mirror and see what we’re becoming.  I, for one, am not sure that this what any of us should accept or condone.  We can do better.  I know because I’ve seen us do better.

You Don’t Understand What We Do

One of the recurring things I see with EMS memes and t-shirts is the theme that “you don’t understand what we do.”  This sentiment is usually expressed along with some gory or chaotic EMS scene intended to show just how hard and heroic it is to be an EMT or a paramedic.  Funny how these scenes never show the more mundane dialysis transfer or posting the ambulance at an intersection.  But I digress.  Being a medic, I understand the realities of EMS, especially the unpredictability, the inability to know what will happen next, and yes, even the occasional chaos.

Last night, a good friend of mine who’s been around EMS for a while told me about an encounter they had with an older medic they occasionally work with.  My friend was explaining and sharing an article about the Folstein Mini-Mental Status Exam, its applicability to EMS, and how the standard chart notation of “A&OX4” for alert and oriented times four is rather insufficient, especially in the legal setting as it is conclusory and often lacks further context or explanation in the medic’s chart. The other medic, let’s call him T-Rex, because he approaches dinosaur level knowledge, argues that he’s been to court multiple times and no attorney has ever challenged him.

Let’s stop right there. Putting my lawyer hat back on, I can, with a pretty high degree of certainty, tell you why no attorney has challenged T-Rex on his documentation.  The documentation of “A&OX4” is not relevant to what the attorney is asking about. I’ll further surmise that, fortunately for him, he wasn’t the defendant a lawsuit in which the patient’s present mental capacity was a key part of the plaintiff’s claim.  In such a case, I can assure you that the questioning from opposing counsel would have taken a much different tone.  Additionally, the questions that the lawyer asked would have most likely been guided by an expert witness or two with knowledge of EMS.  The experience of being examined or deposed by opposing counsel is rarely a fun experience, even when the lawyer comes across as being friendly.  Nay, especially when the lawyer comes across being friendly.  The probing nature of the methodical examination and questioning of each and every aspect of everything you did on that call is the mental version of a simultaneous colonoscopy and root canal, both of which are occurring without the benefit of pain management or sedation.

So, my dear EMS friends, I ask you this.  Don’t presume to understand what a lawyer does, why they do it, or how they do it.  Having had the benefit of law school, I can assure you it’s as foreign of an experience to an EMS provider as the work of an EMS provider is to an attorney.  We just don’t have “cool” t-shirts or memes to tell you how awesome it is to be an attorney or how you don’t understand what an attorney does.  Maybe I should get some t-shirts printed up with Tom Cruise saying, “I want the truth!”

Until the t-shirts get printed, here’s hoping that each of you never have to find out exactly what it is that a lawyer does or how we think.

Opining on Protocols

As Bill O'Reilly says, if you must opine, keep it pithy.  I may not be pithy, but I must opine.  Lately, I've noticed a recurring trend on EMS social media when discussing protocols.  Namely, people are convinced that deviating from protocol makes … [Continue reading]

About Nightwatch

Earlier today, I was reading a post on Facebook from Titus Tero, one of the paramedics featured on A&E's reality show Nightwatch.  I've watched the show several times.  The paramedic in me occasionally winces at some of the clinical and … [Continue reading]

At the very least.

I was talking with a local college EMS faculty member about determining the right hospital choice for the right patients.  She rightly pointed out that emergency physicians routinely deal with patients who are brought to the hospital by themselves, … [Continue reading]

Why is learning bad?

I've been blogging a bit more lately and engaging myself a bit more in the EMS world, both locally and in social media. One continuing theme I notice in EMS is that there's a sizable number of EMS providers who actively discount and discourage … [Continue reading]

No matter how you look at it.

No matter how you look at it, no matter how you say otherwise, the reality is that emergency medical services, whether at the basic life support level or the advanced life support level is, plain and simple, the practice of medicine. Those of us … [Continue reading]

System Abuse. Yet again.

System abuse.  That's a term we commonly hear in EMS.  And as soon as we start talking about system abuse, the talk invariably turns to EMS providers' favorite solution for system abusers.  Namely, the idea that EMS providers should be able to refuse … [Continue reading]

Dear EMT Student

Early this morning, I brought my father to the ER.  He's getting up there in years and he's pretty sick.  You came into the room with several of the nurses.  Having remembered my ER clinicals, I slid over and introduced myself to you and told you … [Continue reading]

Some random observations on what we do

I was having a discussion with one of my favorite younger medics.  He's brilliant; he's got a mastery of the science; he's just convinced he's right and won't always let you forget it.  (Sound like anyone you know?) We reached a couple of … [Continue reading]