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.

Clickbait for you. Frustration for me.

Posted on December 9, 2014 Written by

Right now, the EMS social media is abuzz with a piece of so-called religious rights legislation that’s passed the Michigan House of Representatives.  In short, the legislation allows for a person to claim a religious exemption from other laws that infringe upon their religious rights.  Currently, legislation such as this is most commonly championed by Christian social conservatives as an attempt to nullify local and state gay rights provisions.  Our “friends” at EMS1 are headlining this as “Will Michigan allow EMS providers to withhold care based on the patient’s sexuality?”

Here’s my take as an EMS provider, attorney, and someone who’s analyzed state legislation for over a dozen years.  Oh, and also as someone who completely supports the rights of gays and lesbians, including the right to marry.  This bill doesn’t impact EMS one bit.  Not one iota at all.  Doesn’t even mention EMS. I am not YOUR lawyer (although, for the right retainer and hourly rate, that COULD change…), but I can’t see how this proposed piece of legislation changes the duty to respond and the duty to act for EMS (or the fire department or police either).

Also, the bill has only passed through the Michigan House of Representatives and still has to make it past the Michigan Senate and get the signature of the Governor.  As I’ve said before, the legislative process is designed to kill legislation, not pass it.  The chances of a bill getting becoming law are slightly better than my getting a lucrative basketball contract, but probably not as good as your next EMS shift not getting to transport a non-acute patient.

I blame two parties for this kerfuffle and misinformation.  One, somewhere out there, there’s probably a well-meaning and sincere gay rights activist who took the conclusions of this legislation well past the logical extreme.  Second, the lemmings of EMS social media AND the EMS websites blindly posted this without any research, whether out of a lack of legal understanding, believing in a specific agenda, or just trying to drive up clicks.

I’m going to do something I only do occasionally and only when I’m really peeved. I’m calling a publication out by name.  EMS1 — You guys should know better.

As the great American President Abraham Lincoln once said, “Don’t believe everything you read on the internet.”

Filed Under: EMS, EMS Legal, Law, Politics, Rants

Not nice. Politically incorrect. And probably true.

Posted on December 7, 2014 Written by

The biggest problem with the average EMT education program is that it seems to create a false sense of smug competence in that 120-160 hours of vocational training deems you competent to function as a medical professional. The real learning and progression to professionalism is when you realize that you don’t know what you don’t know.

Because let’s face it, when your “education” consists of war stories from your instructor, clinical shifts where you get a gold star for showing up, and a bunch of shopworn sayings like “BLS before ALS,” “treat the patient not the monitor,” and “give ’em a diesel bolus,” suddenly you realize your medical knowledge and skills are much closer to a Boy Scout first aid provider than they are of a board certified, residency trained physician.

The positive news is that, despite the efforts of some, it’s pretty hard to kill someone with only minimal training.  Of course, so long as mastery is defined by completion of a certain number of hours rather than mastery of the topic, then EMS will be to medicine what shop class is to engineering.

Filed Under: EMS, EMS Education, Rants

I am not a hero

Posted on November 25, 2014 Written by

In my “real” job, I’m sure as heck not a hero.  Reviewing contracts just doesn’t save a lot of lives.

When I’m at my “fun” job on the ambulance, it’s not heroism either.  It’s doing something I’m passionate about.  It’s the pride, honor, integrity, and dare I say, the compassion of providing medical care to people in the worst moments.  (Let’s face it, even if we consider it “BS,” it’s still the worst thing in our patient’s day.)  I walk into houses, businesses, and the street and see humanity at its worst.

I’m hanging out at the Texas EMS Conference this week, learning new things, renewing friendships, and making new friends.  Watching a British paramedic experiencing Texas for the first time is rather funny at times.  Driving through the Fort Worth Stockyards listening to George Strait while you explain the history of our country, our state, and the “Old West” is a perfect way to remind yourself of how special these moments are.  EMS, fire, law enforcement, and emergency medicine creates a special bond and kinship between all of us.

But allow me to digress here into the really serious current events of the day.  Ferguson, Missouri.  I’ve had a few friends who aren’t in public safety or medicine post some pretty snarky comments on Facebook about the grand jury decision, Officer Darren Wilson, and/or law enforcement in general. I won’t hector or lecture you.  All I ask is that you try to be as compassionate to your public servants as you are to the thug culture, the “oppressed” who aren’t really oppressed, the criminal underclass, and the looters.  Take it from someone who sees more than Instagram shots of the Mike Browns and Leslie Cochrans of the world — crime, homelessness, and the drug culture aren’t hip, cool, or funny.  They’re a one-way ticket to self-destruction.

You have a right to those opinions.  The “uncool” people that you mock protect your rights to be hip, liberal, and oh so cool. Me?  I have the right to unfriend you.

Thanks for listening.  I’ll try to be funnier in the next blog.

Filed Under: EMS, Politics

Dear NAEMT

Posted on November 20, 2014 Written by

Hey there, it’s The Ambulance Chaser.

Recently, a friend of mine asked why he should renew his NAEMT membership.  I had to think for a minute.  Then I thought for several more minutes. Finally, I told him I maintain my NAEMT membership because I’m affiliate faculty for one of your continuing education programs and because membership provides me a significant discount on EMS Expo (Every other year in Las Vegas – yes please!).   Another person mentioned the 5.11 clothing discount.

What nobody mentioned was NAEMT’s advocacy for the profession.  Why?  Rightly or wrongly, it’s because a lot of us in the field see NAEMT and its leadership as a self-perpetuating good old boys club advocating for its pet causes.

Some of you who know me away from my blog know that I’ve been in state government for over ten years as an attorney and that I’ve previously been legislative staff here in the Lone Star State and have even worked in political campaigns.   When have I seen or met with a representative from NAEMT or any state affiliate (by the way, Texas no longer has a state organization affiliated with NAEMT)?  NEVER.

What do I see from NAEMT for advocacy?  Ham-handed attempts at influencing Congress.  The EMS Field Bill is a useless attempt at finding another source of money for certain EMS agencies that already excel at writing grant applications.  EMS on the Hill Day is, while well-meaning, just another opportunity for certain EMS leaders to wear full dress uniforms that look like a cross between the Knights of Columbus, Captain Crunch, and a Turkish admiral.

Right now, there’s a discussion on the Texas EMS email list about a Texas Board of Nursing administrative rule that’s been interpreted and applied so as to prevent EMS providers from functioning at their certification level in the emergency room.  How does this happen?  Quite simply.  The nursing profession is organized and knows how to get things done politically.  Our supposed “voice for our profession” is way too quiet in the Texas state capitol.  I’m willing to bet you that the other 49 state capitols aren’t being visited by NAEMT either.

So, NAEMT, here’s the deal.  I’m going to keep my membership up.  I want to go to Vegas cheaper (who doesn’t?). I want my continuing education classes, although it’s a damned shame that we have to rely on so much continuing education to make up for the gaps in our initial education.  And yes, I occasionally want some discounted clothing.

But since I’m a member, I’m going to continue to speak out.  And I’m going to keep asking when you’re going to step up for our profession in a meaningful way.  Self congratulatory photos and press releases mentioning the same old names just aren’t going to cut it forever.

Filed Under: EMS, Politics

Butthurt

Posted on November 3, 2014 Written by

Butthurt seems to be the dismissive phrase that people use whenever people get offended by their post(s) on social media, especially if the offense is rightly justified.

It takes a lot to make me “butthurt.”  Anyone who knows me in real life knows I don’t have much of a filter and that my humor can occasionally make “Truly Tasteless Jokes” seem like it was written by the Mormon Tabernacle Choir.  I’ve had a few jokes that would make a South Park episode seem like Mister Roger’s Neighborhood.  But I do try (and occasionally fail) to keep said jokes between good friends who appreciate said humor.  And yes, I fully understand and appreciate that such gallows, inappropriate humor is a coping mechanism.  And indeed, in many cases, that’s the only coping mechanism we’ve got.

Here’s what gets me butthurt.  When you don’t have the good sense to keep said humor in private.  When you have the poor judgment to post it on a public Facebook page.  When your Facebook page claims to represent EMS.  When you’ve been an EMT for over ten years doing transfers.  When you embrace burnout.  When you ban any critics by bandying about the words “butthurt” and “free speech.”  When you hide behind anonymity — probably because you know the sentiments that you’re expressing are wrong.

None of this would bother me enough to blog about your butthurt except for one thing — you make your Facebook page a public page.  By banning dissenting voices, you lead the average public to think that the average EMT or paramedic is a monosyllabic, drooling cretin who hates running calls and actively withholds pain medications from patients.  You are what’s wrong with EMS.  You’re why EMS providers are barely paid.  You’re why we’re called ambulance drivers.  You’re why, on average, the best and brightest of EMS reach a level of disgust and become nurses, physician’s assistants, and doctors.

And yes, you’re why I’m butthurt right now.

Filed Under: EMS, Rants

Not Everyone Gets a Trophy — or a Patch

Posted on October 28, 2014 Written by

No matter what your view is on what constitutes a “legitimate” request for an EMS response, we all agree (or in theory, should agree) that a patient calling 911 is experiencing a bad day. Even the lowest acuity call deserves a response from an educated, competent, and ideally, compassionate, caregiver, regardless of certification level.

As I look at some of the Internet and Facebook forums devoted and dedicated to EMS, I see a lot of posts full of spelling errors.  I see a lot of posts asking questions that either shouldn’t be asked in a public forum or should be considered common knowledge in emergency medicine.  And of course, I see posts begging for help on passing the National Registry exam on the student’s sixth and final attempt. Many times, I ignore these posts and shake my head.  Sometimes, I let my snarky humor emerge.  My good friend and fellow blogger, EMS Artifact, used to give these shining exemplars of the future of EMS a Mickey D’s job application as a helpful hint.

Why do I not always encourage little Johnny or Susie to “be all they can be” and be a real lifesaver?  Simple.

Emergency medicine is too important to lower our standards to the point that everyone gets a trophy — or a gold colored National Registry patch.  This is why I refuse to coddle students, tolerate poor patient care, or be supportive to the person who asks for help on passing Registry on their sixth attempt.   We’re in the business of caring for the weakest and most vulnerable of society.  That demands high standards.  And if you’re complaining about the lack of professional respect or financial stability in EMS, then we should be setting the standards for excellence — not minimal competence.

If this makes me a paragod or an arrogant prick, then so be it.  Maybe we need just a few more paragods or arrogant pricks in EMS.

Filed Under: EMS, EMS 2.0, EMS Education, Rants

Ten years in

Posted on October 13, 2014 Written by

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.

Filed Under: EMS

(Another) reason why EMS isn’t taken seriously

Posted on September 29, 2014 Written by

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.

Filed Under: EMS, EMS 2.0, EMS Education, Rants, Uncategorized

Things that make no sense in EMS

Posted on September 24, 2014 Written by

1) EMTs and paramedics are constantly told “We don’t want you to know how billing works because we don’t want you to let finances influence a decision to transport a patient.”  Makes sense.  But then we’re told, “If you don’t document this chart correctly, we can’t bill for it.”  So, are we supposed to have an understanding of billing or not?   Personally, I wouldn’t mind a better understanding of billing and reimbursement.

2) When a volunteer service fails, we hear the advocates for paid EMS argue that a community gets the EMS that it pays for.  Exactly.  Please remember that same maxim when a private operator argues that they can provide EMS service to a community for free or a very small subsidy.  These operators will continue to make money by scrimping on pay, minimal equipment, minimum staffing, lowest common denominator protocols, and posting crews at street corners.   And with these working conditions and/or wages, the community will get the kind of EMTs and paramedics they’ve paid for.

3) Final thought from someone who volunteers.  We hear about the death of volunteer EMS.  Sadly, I’m afraid that day may be closer at hand.  But I also think that there’s a place for volunteers still, even if just to supplement staffing and coverage.   All it would take is some organizational commitment and flexibility.  My question is whether we’re really losing volunteers or whether we’re losing organizations that accept volunteers.  Around my neck of the woods, it’s the organizations that don’t want volunteers….

Filed Under: EMS, Volunteers

Monday morning thoughts

Posted on September 8, 2014 Written by

Just a couple of random thoughts to get your Monday morning started.

 

1) In EMS, we’re constantly making noise about going beyond blindly parroting and following protocols, but we continually apply the cookie cutter mindset to any legal issue in EMS. For example, if you don’t do exactly this, you’ll be guilty of abandonment, battery, or some other tort that the average EMS provider remains incapable of understanding, but is an expert because they sat through the PowerPoint slides on medical-legal issues.

2) Nursing (and other health care professions) have made a great deal of noise over the years about not taking abuse from physicians.  Rightfully so.   I’d like to remind nurses that respect is a two way street.  Especially the ED charge nurse who sarcastically asks, “Why’d you bring the patient here?”  That is an excellent question.  I will be sure to recommend the competing hospital network’s facilities, especially since my family uses said network, primarily because of the quality of the nursing staff.

3) Part of the reason, in my opinion, that private EMS gets a bad rap is because so many of the management types there give you the same feeling that you get from the finance guy at the car dealer who tries to convince you that without the rust guard and the extended warranty that you’re placing your family at risk.   Long term success and short term profits aren’t always the same things.  Successful businesses recognize that.

Filed Under: EMS
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