Ten years in

This month celebrates my tenth year in EMS, first as an EMT and now as a paramedic.  (This doesn’t count for the several years I spent as an untrained observer annoying the living daylights out of Lubbock EMS and Austin/Travis County EMS.  Nor does it account for the several years annoying the EMS groups on Yahoo Groups.)

I’m an anomaly.  I’ve passed the average career duration in EMS for most providers.  However, I’m not sure that’s truly the case as my EMS career has been primarily as a “weekend warrior,” doing EMS on the weekends when I’m not practicing law.  So, I probably really haven’t really reached burnout level yet.   Think how bitter, cynical, sarcastic, and jaded I’ll be by then.

I owe EMS a lot.  It’s given me a useful outlet to unwind when I’m not practicing law. It’s given me knowledge that I’ve used for the benefit of family and friends.  It’s given me the confidence to walk into the unknown and care for someone who I’ve never met before and take care of them in the most important moment of that day for them.  I’ve watched someone die in the back of my ambulance.  I’ve hugged family members.  I’ve cried more than once.  Fortunately, I’ve laughed more than I’ve cried.

I’ve learned a great deal as well.   I’ve kept up with the science.  I’ve kept up with evidence-based medicine.  I’ve watched our methods, our treatments, our medications, and our paradigms changed.   There remains one constant, though.  This is the practice of medicine, not merely the science of medicine.  Current treatments matter.   What matters even more is how you treat your patient.

Most importantly, I’ve made some incredible friendships in this field.  I count several prominent EMS “celebrities” as friends.  I’ve had dinner with Randy Mantooth and Bryan Bledsoe at the same time.  (The statute of limitations prevents me from saying any more on that topic.)  I’m also friends with a lot of the “rest of us” as well.  I cannot even begin to measure how my life has improved from having EMS in my life and from having so many of us in the public safety and healthcare worlds in my life.

What I do know is that, when this is no longer fun, I’ll hang the stethoscope and duty belt.  Despite some changes in my EMS affiliations and activities, it continues to be fun and I hope that I have many years left.

I always say that I’m the medic I am because I’m also a lawyer and that I’m the lawyer I am because I’m also a medic.

Thanks for letting me into your world.  I hope I’ve been — and remain — a worthy visitor.

(Another) reason why EMS isn’t taken seriously

EMS providers love to claim that “EMS isn’t taken seriously” by you-name-the-other-healthcare-profession.  And we’re right.  We rarely are taken seriously.  I’ve complained before about some of the reasons why.  (See also: T-shirts with flaming skulls and sayings about “Racing the Reaper” and “Doing Everything That a Doctor Does at 80 miles per hour.)

But today, I stumbled on another reason why we shouldn’t be taken seriously.   EMS professionals of all levels fail to grasp the science behind what we do.  I’m not talking about an EMT being unfamiliar with the Krebs cycle or even a paramedic not being able to explain why Trendelenburg is bunk.

What I’m talking about is more fundamental.  It’s about a failure to understand the scientific method, which subsequently adds to the continued issues with medics lacking critical thinking skills or understanding research.  This morning, I saw at least two experienced paramedics on Facebook hawking pseudoscientific woo as diet/health supplements.   Either they’re con artists or they lack the basic scientific literacy to understand that there’s ZERO science or evidence behind the overwhelming majority of these products.  Let’s not even discuss the amount of EMS providers who are vaccine deniers.  I won’t even give them the courtesy of invalidating their beliefs.  To me, vaccine deniers are the medical version of Holocaust deniers.

And then, there’s the other extreme in EMS.  We have the pedants who claim to be advocates of science and “evidence based medicine.”   All too often, though, these “experts” will immediately advocate massive changes in medical practice based on one journal article.  Sometimes, these experts don’t even critically analyze the article.  Patient who receive morphine in acute coronary events have worse outcomes?  Their solution?  Ban morphine administration.  Critical takeaway — most patients who receive morphine in acute coronary events receive morphine only because the nitroglycerine failed to relieve their chest pain.  Did it ever occur that the patients with more acute pain might be having a more extensive event?  Nope.  To the nattering nabobs of negativity who self-appoint themselves as “EMS research experts,” one journal article is enough to limit the EMS skills arsenal or drug formulary.  Yet, these same experts usually want multiple studies to enhance EMS skills or drugs because “the science hasn’t been proven yet.”  Folks, it’s a rare case when one journal article should change your practice.

I’ve blogged before about the shameful state of EMS legal education.  It’s somewhat understandable as EMS isn’t run by attorneys.  (And that’s probably a good thing, excluding your favorite blogger not named Kelly Grayson….)  But EMS is medical practice.  And medical practice is supposed to based upon science.  For EMS providers of any level to not understand the scientific method and inject a healthy dose of skepticism to most claims is to fail as medical providers.  And that, my dear minions, is yet another reason why we’re ambulance drivers and not healthcare professionals.

Things that make no sense in EMS

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Monday morning thoughts

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Some reasoned justifications in favor of jet fuel and flight suits

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Ice Buckets

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Core Maxims of EMS

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Thinking outside the box on community paramedicine

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It’s not always THAT call

Last night, I had a challenging call.  The specifics don't matter all that much, but suffice it to say that a rodeo cowboy had an isolated extremity injury where he wasn't responding to much of the analgesia options I had for him.  The real issue … [Continue reading]

Being a Sheepdog

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