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.

Paragod? Why yes, I am.

Posted on October 20, 2013 Written by

So, I couldn’t resist commenting on one of the trolling Low Information Voter medic groups on Facebook.  There was a discussion by some sort of EMT or first responder about automatically applying a non-rebreather mask to a patient with a stroke. This provider got upset for the paramedic removing the mask and called him/her a “paragod.”  And since I couldn’t leave well enough alone, I commented.  I probably should’ve lowered my snark factor, but that’s not a fault of mine.  Rather, it’s a value added option.

So, what is a paragod?  From best as I can tell from Central Texas (home of the world’s best BBQ), a paragod is a thoughtless term hurled by Low Information Voter/medics at those medics who they think are “too smart.”

Yep.  I’m guilty.  I’m educated outside of EMS. The liberal arts and legal education means I’m likely to use critical thinking.  I make it a point to attend and participate in continuing education.  Continuing education occurs in card course, in-house CE classes at the department, state and national conferences, and yes, online too.  I knocked out my National Registry transition course and recertified six months early.  I’m the one that a lot of my friends come to when they’re looking for an answer on continuing education. I keep up with the science, because medicine is a science.  Science changes and so the medicine changes.  Sadly, too many people in EMS (especially at the lower levels of certification) cling bitterly to that which was taught to them in their initial education program and blindly follow the protocol cookbook for the recipe to treat patients.  EMS is changing, even (perhaps especially) at the BLS level.  If you don’t know about passive oxygenation, CPAP, permissive hypotension, selective spinal motion restriction, pit crew CPR, or oxygen titration to avoid free radicals, you’re already behind the times.

So, here’s the deal.  I’m going to continue being what you call a paragod.  I’m going to be current on my medicine and the science behind it.  You have two choices — evolve or become extinct.  That’s science, too.

Until then, I remain your friendly neighborhood paragod.  Arrogant?  Honestly, no.  I’m pretty approachable.  I just seem arrogant to the willfully uneducated.

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

It’s my blog…. (Endorsement warning)

Posted on October 14, 2013 Written by

And I’ll endorse candidates if I want to.  I run hot and cold on NAEMT because I know it’s the only association we have that can even claim to represent “all” of EMS, but I also see it fail to live up to its potential regularly — especially in terms of legislative advocacy.

These issues didn’t arise overnight and they certainly won’t be fixed overnight either.  Honestly, I don’t know whether to try to fix things or throw up my hands.   Today, though, I’m hoping that NAEMT can continue to improve.

One way that NAEMT can improve is with strong leaders on the board of director.  It’s truly my privilege and honor to endorse a friend and colleague as he seeks a position as an At-Large Director on the NAEMT Board of Directors.  Troy Tuke is the Assistant Fire Chief for EMS with the Clark County (Nevada) Fire Department.  I’ve known Troy (oops, Chief Tuke) for over seven years now since riding with him (when he was an engineer/paramedic) on my first trip to EMS Expo in Las Vegas.   Chief Tuke is one of the progressive minds in fire-based EMS.  (Yes, they do exist!)  He’s also a registered nurse.  In the years that I’ve known him, I’ve always known his integrity to be beyond reproach and that he is a continual advocate for EMS’s advancement as a profession.

If he doesn’t have three strikes already between being endorsed by an attorney, being a RN, and being a fire chief (I’m kidding, y’all!), I would highly encourage any NAEMT member to vote for Troy Tuke as an at-large director.

Thanks — and the snarky posts will be back soon.

Filed Under: Uncategorized

Monday morning harshness

Posted on October 14, 2013 Written by

So, this morning, my Facebook feed subjected me to a post from a fellow EMS provider who shared a maudlin post from a Facebook EMS group about how important it is to be nice to patients on nursing home transfers because, OMG, you’re like the only person in their life.  Or something like that.

Ok, here’s the deal.  Be nice.  It’s simple.  It’s easy.  Honestly, it’s probably even part of the job, despite the number of people who think that a t-shirt with the tagline “EMS: Here to save your ass, not kiss it” is perfectly appropriate.  And studies show that nice medical providers get sued less often.

BUT…. Don’t give me some made-up, tear-jerker story or Facebook post to shame me into being nice.  I don’t need that kind of juvenile coaching.  (This kind of stuff is why I hate so many of the customer service and/or ethics speeches, articles, and presentations in EMS.) And if you do need that kind of reminder to actually be nice, I saw a couple of fast food places that are hiring.

Filed Under: EMS, Rants

Controversial post for the week

Posted on October 9, 2013 Written by

Time to stir up some controversy here.

If I was an EMS medical director (Yes, I know, scary thought in and of itself.), I would no longer require any resuscitation “card courses.”  No more ACLS, CPR, or PALS.   Why?  Several reasons.

1) The “current” science behind the current ACLS/PALS/BLS-CPR standards is already dated.  New science is regularly coming out about cardiac arrests.  What about dual defibrillation?  Therapeutic hypothermia initiated during the arrest?   Nope, not in the current standards.  Mechanical CPR devices?  Barely mentioned Heck, the “pit crew” model of CPR which is rapidly becoming the de facto standard of care for EMS CPR isn’t even accepted by the AHA yet.  If you think John McCain and Ted Cruz are conservative, the AHA’s resistance to new changes is legendary.  Heck, it wasn’t even until this go-round of ACLS revisions that waveform capnography was added.

2) Between the AHA and JCAHO wanting/encouraging virtually every nurse, physician, and respiratory therapist to have a current ACLS card, the ACLS standards have become a laughing stock for those people who are actually expected to perform resuscitations.  The “everyone gets a card” mentality means that the current courses have become another example of the “everyone gets a trophy” mentality that permeates our country right now.

3) And besides, for those of us in the EMS world, our local protocols are going to override a “canned” card course anyways.  Thank goodness for that in most cases.  I’d rather work a code the Austin/Travis County EMS, Wake County EMS, or Harris County Emergency Corps way than the already-dated, hospital-oriented “card course” way.

In fact, if I was a medical director, the only card courses I’d require would be Advanced Medical Life Support (AMLS) and PreHospital Trauma Life Support (PHTLS).  Those are courses designed for EMS providers and based on assessment, not blind parroting of rote, already dated protocols.   It’s time EMS progresses beyond rote memorization and embraces assessment-based interventions and sound science.  Kudos to those EMS medical directors and EMS systems who’ve moved their protocols to accept the current science — and who don’t let the possession of a “card” define competency or currency in resuscitation science.  I know for certain that Austin/Travis County EMS no longer requires BLS-CPR cards in recognition of their higher standards with “Pit Crew” CPR training.  Similarly, Cypress Creek EMS (near Houston) no longer requires ACLS cards of their paramedics in recognition that some of their clinical standards exceed current AHA guidelines.  Take the plunge — and free yourself from the tyranny of sitting through the same biennial DVD presentations.   We’re EMS.  Cardiac arrest is a huge chunk of why we were created in the first place.  We’re supposed to OWN resuscitation.  Let’s show it — by educating ourselves ABOVE the standard.

Thoughts, y’all?

 

 

 

Filed Under: EMS, EMS 2.0

Do what you do best and OWN it.

Posted on October 8, 2013 Written by

Lately, I’ve been thinking about my blog and also about speaking engagements.  In fact, a fellow blogger and I were discussing conference topics.  She and I were both complaining about some of the topics that people seem to like us to speak or write about.   For a while after getting into EMS, I wanted to be known as something other than the paramedic/attorney who speaks about legal issues.   So, I tried a few presentations on clinical topics.  They went over OK, but that’s not what people wanted to hear about from a paramedic/attorney.  Truth be told, I know several people who do much better “medical” presentations than I do.  Kelly Grayson and Bryan Bledsoe are both phenomenal speakers who have a real ability to take a difficult medical topic and put it into terms that a rookie EMT can master.

 

Over time, I began to realize something, namely that Kelly and Bryan (and most other EMS types) aren’t attorneys.  And I know that I can present a medical-legal lecture that’s fun, informative, and accurate.  Being an attorney and a paramedic is something kind of different in our EMS world.  So, I’ve become one of the few people who OWNS the medical-legal topic.  (By the way, I also OWN the topic of turning a volunteer program into a success.  More on that in another blog post.)

So, back to my friend.  She says that her most popular blog post was about dressing professionally.  My advice to her — OWN the topic of EMS professionalism.  It’s something that needs doing well.  With the amount of “low information medics” on social media, we all need a reminder about acting professional.  Even worse, so many of the popular EMS columnists and authors who write about ethics and professionalism come across as overly moralistic scolds whose shaming of natural human responses would make the Spanish Inquisition blush.  Anyways, I hope she OWNS the topic of EMS professionalism.

What’s your EMS topic that you’re passionate about?  OWN it — and share that passion with your colleagues and others.

Filed Under: EMS, EMS Education

Public Outreach

Posted on October 7, 2013 Written by

Why are the fire service and law enforcement considered essential public services and EMS is rarely considered, if at all.   Why do politicians and opinion leaders buy the “snake oil” from some private EMS operations about operating for little or no subsidy and not understand what they’re getting for that little money?

The answer is quite simple.  It’s because no one knows what EMS does.  And we have ourselves to blame.  We’ve done a great job of handing out “Call 911” stickers.  People have gotten the message to call 911 for EMS.  The problem is that they don’t know who EMS is, much less what we do. With such a lack of public education, can we blame people when they call 911 for a prescription refill, but don’t call EMS when they’re having crushing substernal chest pain radiating to the jaw and down the left arm?

I have a variety of friends in a variety of professions.  I’ve had to correct attorneys as to the difference between an EMT and a paramedic.  I’ve had an ICU nurse ask me what IV antibiotics I stock on my ambulance.  And tonight, a police lieutenant told me he had no idea what EMS did, but that he appreciated them dealing with intoxicated college students.

And how does EMS respond to this lack of knowledge?  In most cases, the same ways we’ve always dealt with it.  “Call 911” stickers, blood pressure checks during EMS Week, and then complain about the lack of respect that EMS gets even during EMS Week.

Folks, people still see us as barely educated ambulance drivers.  It’s because we haven’t taught them anything.   The fire service and law enforcement embrace the public education mission.   EMS doesn’t.  Plain and simple.   The cops and the firefighters have “citizens’ academies” where they show off their organizations and answer questions.  EMS claims we can’t because of HIPAA, lack of funding, or vague concerns about liability.   We need to be showing off — opening the ambulance doors up for real tours — where we show what we can do, allowing ride-alongs, and reaching out to the media.

The people who we don’t educate about what EMS does and why a well-funded, clinically progressive EMS system makes a difference are the same people who are going to call 911 at 3 AM because they ran out of their Xanax.  Perhaps even worse, the same people that we don’t educate about EMS are the volunteers that never joined or the community leaders that don’t support the next tax election or fundraising drive.

Filed Under: EMS, EMS 2.0, EMS Politics

The Dreaded Medical-Legal Lecture

Posted on October 3, 2013 Written by

Everyone who’s been through EMT or Paramedic classes vaguely remembers their medical-legal class.  You know, the one that the instructor stumbled though.  He or she probably just basically read the PowerPoint slides verbatim and maybe told some old wives’ tales.  (No offense to old wives.  They’re welcome to read my blog too.)  And the material in the textbook?  Equally vague and nebulous.  This is where you end up with falsehoods like “If I have an EMS sticker on my personal car, I have to stop at any car wreck.” My personal favorite myth is the one about being able to report child/elder abuse to the nurse or social worker in the emergency room. (By the way, that myth may cost you your certification in some states!)

In almost any other part of an EMS education program, we’d never tolerate a lecture to be taught by someone whose only education on the subject came from their initial EMS education.   Can you imagine cardiology taught by someone who’d only sat through the cardiology lecture and never had touched a cardiac patient or even had an ACLS card?  The program would likely be considered a joke at best.  And good luck getting the state or CoAEMSP to accept the program.  (More on accreditation in a future post, by the way.)

Yet, we continue to accept allowing the (dreaded) medical-legal lecture to be taught by virtually anyone with an EMS certification.  Whether for better or worse, we continue to cling to the falsity that EMS legal issues are the same from state-to-state.

A few suggestions to improve EMS legal education:

1) Actually invite attorneys to guest lecture.  Difficult/technical topics beyond an instructor’s skill set should be taught by experts.  (Conflict warning:  I actually give a fun medical legal guest lecture.)

2) Remove specific legal issues from the educational standards.  State laws on negligence, abuse reporting, and Good Samaritan issues vary from state to state.  Teaching the general rule is a disservice to students.  That also means not testing on these issues on the Registry.  Many states require a separate medical-legal exam on state regulations for physicians.  Maybe that should be considered for EMS as well.

3) EMS students should be regularly quizzed/challenged on their documentation.  Documentation practices should be taught as a means of avoiding legal liability rather than the emphasis that employers may have on billing.

4) And, as an absolute must, each EMS student needs to be taught, at the very least, how to find their state’s EMS statutes and regulations.  In the ideal world, state EMS regulators should provide an introduction to the legal issues and regulatory framework in their state.

As the old maxim goes, ignorance of the law is no defense.  Sadly, in EMS, we have so many instructors educating students who now have no defense.

Filed Under: EMS, EMS Education, EMS Legal, Law

You’re not that special. Really.

Posted on September 23, 2013 Written by

So, you think that your EMS system is broken?  Maybe even that EMS is broken?   And you’ve got the solutions: enhanced education, independent practice of paramedicine, an expanded scope of practice, getting rid of the deadwood, and definitely increasing the pay.

Well, la-di-da.  Welcome to the party.  You’re by no means the first and won’t be the last either.  Plenty of smart people have tried to do the same things.  The state of Texas initially was going to create a new level of paramedic to do just that.  In the legislative process, it got watered down to be the same level of paramedic, but with an associate’s degree or higher.  (See “licensed paramedic” in Texas.)   Several bloggers have pushed for EMS 2.0.   Mark Glencourse and Justin Schorr in particular.   Big name EMS educators like Kelly Grayson, too.   And the EMS Agenda for the Future started out with pretty lofty educational standards that were lowered to meet the needs of certain providers.

Plenty of people as smart as you (or even smarter) have said the same things.  Just as many of them have been like shooting stars — burning brightly, then fizzling out (or even crashing) rapidly.   Heck, I’ve even been in that fight myself.  (See my formerly ongoing pointless battle with a large third service EMS system about credentialing first responders as advanced providers.)

So what to do?  Simple.  Find the best EMS system that you can practice in.  One that works for you.  Make it the best place to be a medic that you can make it.  And the bad stuff?  The parts you don’t like?  Roll with it a little.   Things can be a lot  worse.

In the words of Kenny Rogers, “You got to know when to hold ’em, know when to fold ’em,
Know when to walk away and know when to run.”

Filed Under: EMS, EMS 2.0, EMS Politics

The beginning of Top Gun

Posted on September 23, 2013 Written by

Aside from Blazing Saddles, Top Gun is probably one of my favorite movies of all time (as well as being a huge inspiration for me to apply to and attend my first semester of college at the United States Naval Academy).

At the beginning of the movie, there’s a scene that I think we need to see more of in EMS.  After the encounter with the (fictional) MiG-28, Cougar tells his commander, “I’m holding on too tight.  I’ve lost the edge, sir.”  He then turns in his wings. In short, he showed an incredible sense of personal integrity and professionalism in recognizing that he was no longer the best of the best.

At the risk of contributing to the perception that EMS “eats its own,” that’s something I’d like to see more of EMS.  Sometimes, it’s time to recognize that either temporarily or permanently, you’ve lost the edge and it’s time to step back from a role where you’re entrusted with a patient’s well being.  Whether it’s burnout, a lack of confidence, or a lack of ability, being a real patient advocate means that you also have to know when it’s time to step away.

I’d have a lot more respect for a former medic who stepped away than so many people who remain in EMS past the point of burnout, seeing it as another job, and not recognizing that it’s a privilege to be entrusted with patient care.   Of course, this leads into the fact that we need career tracks in EMS.  But that’s another topic for another day.

Filed Under: EMS

Don Quixote, Perfection, Mentoring, and EMS

Posted on September 22, 2013 Written by

Whew, that’s a mouthful.  And my apologies if this blog post comes across as a stream of consciousness rambling.  I’ve got a lot on my mind about some recent observations on some of the EMS Facebook groups.

A few weeks ago, I got “added” or invited to an EMS Facebook group that’s obviously populated by some pretty smart, perceptive medics.  As I’ve already shared my opinion of Facebook EMS groups and the “low information medic” demographic they skew towards, I was happy and excited to join such a group.  However, it’s pained me to watch the Don Quixote habit of tilting at windmills pop up.

Many of the best and brightest in EMS have tilted at EMS windmills over the years.  Bryan Bledsoe has done a great job at pointing out many of the flaws in EMS.  He does it with science, logic, reason, a dash of humor, and an incredibly likeable personality.  Unfortunately, so many of the super smart people in EMS who choose to tilt at the windmills fail in two aspects.  First, they have an incredibly poor sense of timing and perception.  Second, they tend to come across like Sheldon from The Big Bang Theory or The Comic Book Shop Guy from The Simpsons — socially awkward, judgmental, and more than a bit smug.  (Think about it, politics and music aside, socially, would you prefer to hang out with Ted Nugent or Moby?)

Pick our battles.  Yes, there are some low information Facebook groups out there that prey on the lowest common denominator of EMS.  Are we going to be able to change them?  Probably not.  However, those are not the people who are going to advance EMS.  If we pick our battles and learn how to work within the system, in future years, those same low information EMS types will still be on the transfer truck while the smart ones will be in management and clinical development positions.

Find like-minded individuals.  Associate with them, whether formally or informally.  Our national EMS association may have its issues, many of which I’ve blogged about before, but it will still be easier to fix EMS and our EMS association from within rather than merely complaining from the sidelines.  There are plenty of us who are still passionate about making EMS a profession.  Imagine what we could do if even 10% of us decided to run a slate of candidates for our EMS association.   Remember, politics is the art of the possible.  It takes compromise and deal-making to get things done.  These aren’t dirty words — just reality.

Until then, here’s some advice.  First, don’t argue with a moron.  They drag you down to their level and then beat you with experience.  Second, don’t let perfection be the enemy of the good.  I’ve had more than one instance in my EMS career where I wanted perfection instead of what worked.  In the process, I left more than one good place in EMS — and possibly burned some bridges in the process.  Finally, seek out a mentor.  I’ve been blessed to have several mentors in my EMS life.  They’ve given me sage counsel, especially from two perspectives. Number one, the “I wouldn’t do that if I were you” reminder.  Number two, the “Been there, done that” reminder.  If you don’t have a mentor in your vocation or avocation, you’re not setting yourself up to be a complete success.   Many thanks to the mentors I’ve had along the way of my EMS (and legal) career.  I shudder to think how many more mistakes I could’ve made.

Filed Under: EMS, EMS 2.0, EMS Legal, EMS Politics, Law
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