Licensed Texas attorney. Licensed Texas paramedic. Unlicensed BBQ critic.

Licensed Texas attorney. Licensed Texas paramedic. Unlicensed BBQ critic. And yes, I went to law school first. Got to learn how to chase the ambulance before you can drive it. Politically incorrect infidel who's very conservative. . Oh, and also a big fan of country music, firearms, and, as of late, cars.

Another example of not talking to the lawyers.

Posted on December 12, 2015 Written by

One of the recurring themes that I notice about EMS and about EMS management in particular is that people regularly avoid asking a lawyer for advice and instead rely on what they think a lawyer would say.  Of course, without the benefit of law school, your legal opinion is about as dangerous as relying on a Facebook post promoting raw cinnamon or vinegar instead of chemotherapy or surgery to treat cancer.

I regularly see these examples of legal sophistry masquerading as “protecting the organization from liability.”  I usually have a knowing chuckle at these instances. But today, one just captured the prize for “what the heck are they thinking?”

I have a good friend who’s a paramedic for an unnamed Scandinavian EMS operation that’s expanding into the USA.  Said friend of mine is also one of the smartest people I’ve ever met with an EMS certification.  He reminds me a lot of myself a few years ago.  He’s smart and eager to improve EMS.  Like the old version of the Ambulance Chaser, though, he’s also impatient and more than willing to tell you that your’e wrong.  When he becomes older, wiser, and more tactful, I have no doubt that he’s going to change EMS.

Recently, he posted a picture of teaching his partner some airway management techniques.  Shortly after that, he was disciplined for “unauthorized training.”

Yep.  Let that sink in.  Unauthorized training.  What kind of corporate nimrod came up with that?  Clearly not someone with a either the benefit of law school or any current knowledge of EMS practice.  When the literature says that EMS providers are terrible at airway management, that airway training is lacking in EMS initial education, and that continuing opprtunities to practice and master airway management are lacking, we have some corporate lackey discplining a medic for maintaining mastery of his profession and for sharing his knowledge with another medic.  Corporate is more worried about the training being authorized than about the medics under their employ receiving any training in airway management at all.  Risk management, indeed.

All I can to those people is that the Ambulance Chaser’s unofficial opinion is that you’re a bunch of Falcking idiots.

Filed Under: EMS, EMS Education, EMS Legal

The Five Most Dangerous Words In EMS

Posted on December 7, 2015 Written by

There are a lot of phrases that encapsulate the “meets minimum standards” mentality that continues to hold back EMS.  However, one phrase continues to exemplify why EMS is relegated to being considered “unlicensed assistive staff.”

That phrase is : “Don’t need to know it.” This phrase captures the anti-intellectual bias that exists in EMS. (For example, “You don’t need book learning, let me teach you how we do it on the streets.”)  This phrases captures the blind faith in dogma, whether spread by their instructors, their colleagues, the National Registry, or what someone who thinks they heard about a legal case from two states over…

As we engage in fitful efforts to embrace mobile healthcare, particularly in dealing with long term chronic care patients, we’re going to find that our education is massively lacking in virtually any topic other than those topics tailored for a select few acute/critically ill and patients.  Paramedics have less clock hours in the classroom than most beauticians.  EMT programs are usually less than a quarter of the length of paramedic programs.

If anything, EMS should be pounding on the doors of educators asking for MORE knowledge and becoming life-long learners.  But instead, the sheep of EMS continue to bleat “Don’t need to know it.”

And now you know my skepticism when people claim that a new, improved EMS paradigm is just around the corner.  But I’m enough of an idealistic to keep tilting at that windmill.

Filed Under: EMS, EMS 2.0, EMS Education

Revisiting Paragods

Posted on November 30, 2015 Written by

A regular theme in the social media EMS world is the use of the word “paragod.”  With that in mind, I present you my thoughts that I recently shared in an EMS education group.

You are responsible for your own education, learning, and mastery of medicine. Bandying about the term Paragod when you think someone is smarter than you shows an incredible lack of maturity and a lack of acceptance of professional responsibility. We’ve been entrusted to care for the sick, injured, weak, and vulnerable. To me, that means that the obligation to care for them is above your sense of self-esteem. Rest assured that there is always someone smarter than you in this field and if you choose not to be challenged by new knowledge, you’re part of the problem in EMS.

In other words, I embrace the term Paragod.  I am responsible for my own learning. I am a guardian of our profession. I will help you reach your goals. But I am not going to do your work for you or hand you the knowledge.  The reasons are simple.  One of these days, you could be my partner or you could be caring for one of my loved ones.

Part of EMS developing a professional identity means that we maintain standards for our profession.  Just not like not everyone gets to be an astronaut when they grow up, not everyone can or should be a paramedic or EMT.  If that makes me a Paragod, then call me a Paragod.  I’ll wear the title with pride.

Filed Under: EMS, EMS 2.0

Challenges to Mobile Healthcare

Posted on November 30, 2015 Written by

As is the case in EMS every so often, we’ve attached ourselves to the supposed “next big thing” that will ensure adequate EMS funding, give EMS a level of professional respect, and provide for cleaner, minty-fresh breath.  As of late, that latest panacea is “community paramedicine” or “mobile integrated healthcare.”

Before I inject the lawyer’s skepticism, let me say that I wholeheartedly support an expanded role for EMS professionals in the world of healthcare.  I believe that EMS professionals are vastly underutilized in the healthcare field.  Personally, I believe that a variety of clinical settings would benefit from EMS providers being on site as a “rapid intevention team” to respond topatients who are acutely ill and/or rapidly decompensating.  Our ability to think under pressure, independently, would go a long ways towards improving patient outcomes.

However, let me throw out a couple of concerns with how/why “mobile integrated healthcare” may not yet be the solution that fixes EMS’s perceived woes.

  1. Who’s going to pay for this?  Right now, there are a lot of pilot programs being funded from a variety of sources.  Eventually, this funding is going to dry up and/or the funding is going to have to continue past a trial/pilot period.
  2. EMS providers are pretty darned good at reacting to acute events.  Many EMS providers don’t yet have the education in patient assessment, pathophysiology, and pharmacology to be effective in a longer-term setting.
  3. Attitude.  Sadly, look at the number of EMS providers out there who want to limit themselves to a minimal standards mindset and who don’t even see themselves as healthcare professionals.  Thrse are the same ones who recite the shopworn mantras like “diesel bolus” and “we can’t diagnose.”  “You call, we haul” is their mentality.

So, what will fix EMS and give us a place at the adult table in healthcare? I thought you’d never ask me.

  1. EMS needs to be reimbursed/paid for the care/interventions we provide, not solely as a glorified medical taxi with reimbursement for transport.
  2. We need to develop an identity of who we are and what we do.  Further, we need to ensure that, like any other regulated profession, we do not let others intrude into our professional, regulated space.
  3. Let’s embrace what EMS excels at — namely, using a public safety framework to deliver unscheduled, acute or urgent care medicine.

How can we achieve this?  We have to do the one thing that nursing beats EMS in every day — advocacy.  We need to be at the state capitol and in the halls of the regulatory agencies advocating for the future of EMS, rather than having various “stakeholders” define who they want EMS to be.  A professional identity would go a long ways towards making EMS a respected healthcare field.  The problem is that we aren’t educating the public and we aren’t making our presence known at the state house or at the myriad of regulatory agencies with oversight of what EMS does.

Of course, none of this is easy.  It’s a lot easier to look for the “next big thing” or maybe find a new t-shirt slogan.

Filed Under: EMS, EMS 2.0, EMS Education

Here, this is your license to learn

Posted on November 19, 2015 Written by

I recently heard a good friend of mine say that she’s “just” a basic, because she recognizes the limits of what she can do — and presumably, what she knows.

Well and good. The first step in becoming a proficient provider, in my view, is to know that you don’t know what you don’t know.   That applies to everyone from the newest first aid provider to the most experienced subspecialist physician.

But the next step is to realize that while scopes of practice may be a limit, there’s no law, statute, regulation, or administrative rule that creates a scope of knowledge.  In other words, there’s no limit to what any provider can learn.  Will they be able to do a new skill?  Probably not.  But having the knowledge doesn’t always reflect itself in a skills base.

So, my advice to each of you is simple.  Keep learning.  Challenge yourself with increasing your knowledge base.  EMTs shouldn’t be afraid to read a paramedic text.  Paramedics should be reading medical texts. (In my opinion, it’s imperative to have both Tintinalli’s and Harrison’s on your bookshelf if you’re an advanced provider.) The purpose of continuing education, which we as EMS providers keep forgetting, is to enhance our knowledge, not merely repeat the same classes to check off the same requirements.

Maybe, just maybe, when EMS providers recognize their certification card as a license to learn, not merely as a sign of achieving their career objective, we can be recognized as EMS professionals.

The Texas EMS Conference starts this weekend.  I’ll be there with my license to learn.  Will you?

Filed Under: EMS, EMS Education

On Associations

Posted on November 6, 2015 Written by

As most of y’all know, I’m a native Texan.  I’m proud of being a Texan.  (Just ask me about BBQ and our better country music.) I’m equally proud of Texas EMS.  I believe that our regulatory structure and environment have created some excellent EMS systems and some of the best EMS providers in the United States.

As many of you know (or should know), we now have a new state EMS association in Texas, the Association of Texas EMS Professionals. There have been a few nattering nabobs of negativity questioning the need for a state EMS association and/or the motives of the founders.

As a member of the association, a paramedic, and an attorney, I feel a bit qualified to explain why a state EMS association is a must, as well as what it should and shouldn’t be doing.

A state association of any sort exists for one primary reason — to advocate at the state capitol for the profession.  Primarily, that means legislative advocacy as well as advocacy with the regulatory agencies.  As we know, many of the EMS rules and regulations receive little input from EMS. It is well past time that we as EMS professionals advocate for own profession and identity rather than allowing other “stakeholders” to define the world of EMS.  As most EMS laws and regulations exist at the state level, having a voice at the state capitol is critical for EMS.

Our national EMS association, the National Association of EMTs, exists especially to advocate for EMS in Washington, DC with the federal government.  My occasional gripes aside, they’ve made great strides in giving EMS a voice both on Capitol Hill and with the myriad of federal agencies who have a regulatory stake in EMS.

I’ve heard some moans and gripes from some EMS folks who want our state association to intervene in employer/employee disputes and advocate for wage increases.  Quite simply, that’s not how this works. State associations don’t exist for this reason.  Local associations and/or unions are the best place for advocacy with a specific employer.

A stool needs three legs to stand.  EMS needs those same three legs to stand — and thrive. For me, those are memberships in associations that advocate nationally, on the state level, and the local level.

It’s time for Texas EMS to take the next step.  Join me and the other Texas EMS providers who’ve invested $49 in our future by ensuring we have a voice at the Texas Capitol.

Filed Under: Uncategorized

I’m baaaack

Posted on November 5, 2015 Written by

After some technical difficulties and some writer’s block, the blog is back up and I’m back.  I’m thinking of some EMS topics to inspire me.  For those of you who’d like to hear me live, in person, I’ll be speaking at the Texas EMS Conference in Dallas.  More to come — and glad to be back.

Filed Under: Volunteers

The continuing education sham

Posted on June 26, 2015 Written by

Every now and then, I see online EMS continuing education providers engaging in some pretty unethical behavior.  I’ve seen multiple sites reposting copywritten blog posts from other EMS providers.  I’ve also seen resuscitation card courses (ACLS, CPR, PALS) offered from questionable accrediting bodies that aren’t accepted by most state EMS agencies, most employers, or the National Registry.

The majority of us in EMS accept this because we don’t take continuing education seriously.  It’s merely another requirement to be pencil-whipped through, just like the truck check.

The real purpose of continuing education SHOULD be to keep current with the science, practice, and art of medicine.  Yet most of us sit through whatever our employer provides and/or mandates and find the cheapest options for everything else.  I’d surmise that less than 20% of EMS providers have attended an EMS conference of any form.  I’d doubt that most providers participate in the FOAM concept of free open access medical education.   Rather, con-ed becomes an exercise in minimal effort exerted to maintain minimal standards. And in most cases, con-ed becomes another ritual in which the masses repeat the dogma they learned from their instructors and, as such, maintain their certification for another cycle. As such, the majority of resuscitation science has devolved into pressing play on the DVD and parroting back cycles of drug doses.

Say what you want about college degrees or pay raises.  This right here is a large example of why we aren’t considered a profession.  In other words, this is another example of why we don’t have nice things in EMS.

Filed Under: EMS, EMS Education

Thoughts On The Detroit EMS Incident

Posted on June 25, 2015 Written by

If you’ve been around any of the EMS social media over the past two days, you’ve heard a story about a Detroit EMT who refused to respond to a baby in cardiac arrest.

Were her acts disgusting?  Absolutely.  Are they immoral?  You bet.  Do they violate every ethical norm that EMS provider subscribe to?  Damn straight.

Should she lose her job?  Already happened.

Should she lose her EMS certification?  I’d argue that she should.

Should she be sued and held liable in civil court?  I’d love to take the case.

But of course, everyone in the social media world wants more than that.  They want her charged with a crime.

As the resident curmudgeon attorney in these parts, let me dump some cold water on that. After that, I’ll dump some more cold water on that.  First, tell me the crime to charge her with.  Second, can you tell me the elements of the crime?  Why?  Because you’re going to have to prove each and every one of them beyond a reasonable doubt to a jury of twelve people who aren’t smart enough to get out of jury duty.

When actions are so repugnant that we all turn our heads in disgust, our visceral reaction is to say that some sort of crime must have been committed.  The good news, and yes, it’s truly good news, is that our country and our legal system make it incredibly hard to charge, prove, and convict someone of a crime.  Rightfully, we’ve created an incredibly high standard of proof for criminal cases — because we are taking away someone’s freedoms.

Our individual rights should never be subject to the whims of a majority, much less a vocal minority.  As an American, I believe in our freedoms enshrined in the Constitution.  As an attorney, I’ve sworn to uphold these freedoms.  As an EMS provider, I wish that more of my colleagues appreciated these principles.

Filed Under: EMS, EMS Legal

System abuse? Not really.

Posted on June 2, 2015 Written by

A continuing recurring theme in EMS social media and in EMS in general is that we believe there’s a such thing as “EMS system abuse.” Usually, this manifests itself with some meme or catchy saying that 911, EMS, and/or the emergency room are reserved for “true emergencies.” Allow me to just say one thing – WRONG.

Let’s take it piece by piece. First, even for non-profit or government organizations, medicine is a business. Businesses exist to make money. When’s the last time you saw McDonald’s or a law firm tell you not to use their services? Does a lawyer tell you that your routine, uncomplicated will could be done with will-writing software? No lawyer would do that and remain in business. What makes emergency medicine so different? Why do we feel it’s in our best interest to turn away patients? And let’s face it – patients are another name for customers.

Next, imagine the worst EMS provider you work with. Would you trust them to be the “gatekeeper” that decides whether your family gets EMS treatment or whether that EMS provider gets to go back to his station and return to his Xbox? Take an average EMS provider instead. How many of us know enough medicine, pharmacology, pathophysiology, and assessment to make a good, informed decision about sick or not sick? While my blog isn’t meant to be a journal review, the current evidence shows that the majority of EMS providers don’t have the clinical sophistication, knowledge base, or good judgment to make the right call as to not transporting (or transporting to alternate destinations). As an attorney and medic, I can tell you the risk of allowing the average EMS provider to function as a gatekeeper to emergency care is too great. Yes, there are clear-cut cases of abuse of 911, but the temporary satisfaction that an EMT or paramedic gets from refusing to transport one specific patient is not going to address the underlying pathological issues that patient is dealing with – and the best place, under ourcurrent model of emergency care, to begin that process is the emergency room.

In my opinion, what we are really dealing with is the failure of modern medicine to meet the needs of a modern society that functions 24/7. I recently had a medical issue that took several office visits to my physician’s group practice, ranging from urgent care, to my primary care physician, and multiple specialists. Each of these visits (save the urgent care visit) took me away from my work and had multiple co-payments. Factor in the cost and convenience factors, especially with referrals and imaging, and it’s hard to say that I’m actually the intelligent user of medical care. Meanwhile, someone goes to an emergency department, and even if they wait, there’s access to an exam, lab work, at least some imaging, and the ability to consult/refer to a specialist.

The so-called “abuse” of emergency care may be a problem. Belittling those who use our services is 1) not the way we should treat our fellow man; 2) financially counterproductive; and 3) clearly not working. Maybe it’s time to adjust our medical care to account for after-hours availability and the need to meet unexpected/unscheduled healthcare problems.

Until then, it’s my personal belief that if your office phone number is 911 and/or the sign says “Emergency” on your workplace, then you’re first and foremost in the problem solving business. Let’s solve the problem of availability and access to quality care. We can do this – and do it without belittling those we see as beneath our expertise as emergency clinicians.

Filed Under: EMS, EMS 2.0
« Previous Page
Next Page »