About That License

Posted on January 27, 2015 Written by

I get it.  Becoming an EMT is a big accomplishment for many, even including me years ago.  It was pretty cool to know about things and do things that the “rest of us” don’t get to do.  And the same is true if and when you make the jump to paramedic.  You might even get some neat t-shirts to flaunt that you’re an EMT or a paramedic — and especially proud of it.  The really neat part is that your state gives you a piece of paper or plastic that identifies you as an EMT or paramedic, which means you’re “officially” able to do EMS things.

I have another card in my wallet as well.  It’s my card from the State Bar of Texas that identifies me as a Texas attorney.  It means that I get to do things that others can’t do.  It’s a bit of a long road to get one of these cards.  It takes a four year undergraduate degree followed by three years of law school.  Then, the licensing exam.  It’s a two and a half day exam, given only twice a year.  And it means I get to give legal advice and represent (and counsel) clients about the law.   When you learn the law, you learn that few things are in a vacuum.  A statute alone means very little.  You need to look at the definitions that might be found in other places.  You need to look for relevant court cases applying the statute.  You need to look for regulations implementing that statute. And then you figure out how all of these things apply to the facts of your client’s case.

So, when as an EMT or paramedic with the benefit of a four hour medical legal lecture that was read by another EMT or paramedic who’s not an attorney and the slides were prepared by the textbook feels that they know the law enough to read a statute back to me and claim that’s what the law is, I do get a bit offended.  In my world, that’s the same as some attorney who’s not a paramedic hooking someone up to an IV because they saw a YouTube video.   Just like there’s more to being an EMT or paramedic than knowing how to do some random skill(s), there’s more to being an attorney than reading back a statute.  That’s why it takes a while to become a lawyer.

And that, my friends, is why I get offended when some EMT feels that they know what I know based solely on reading a statute and misinforming their colleagues.

In conclusion, I’m incredibly proud to be trusted by my state as both a paramedic and an attorney.  And I will continue to protect both of my professional identities from those who haven’t been admitted to practice in either profession.

Filed Under: EMS, EMS Education, EMS Legal, Rants

If We’re Truly Doing Everything Doctors Do, But At 80 Miles An Hour

Posted on January 20, 2015 Written by

Look around the EMS social media world for any period of time and you’ll see a bunch of worn-out clichés.  One of the more popular ones is “We do everything a doctor does, but at 80 miles an hour.”

Ok.  I’ll accept your cliché.  And being a betting type, I’ll raise you one.  Let’s assume and accept that we, as EMS providers, are practicing medicine — because we are.  And we’re even diagnosing patients.  (Let that one sink in for a moment.  I’ll wait.)

Ok, you’re back.  So, yes, we’ve accepted the position that EMS providers are practicing medicine.  That means we’re getting a medical education as well, right?  And said medical education, regardless of how and where it’s delivered, should be at a level above high school, shouldn’t it?

You’re darned right it should be.  As I’ve mentioned in the past, for the paramedic provider, we’re trying to condense the critical parts of a bachelor’s degree, medical school, and an emergency medicine residency into, at best, a two year program.  That means there’s a lot of knowledge coming at students quickly.

Yet, of all of the education programs out there, EMS education seems to operate on the open enrollment model.  Did your check clear?  You too can try to become an EMT or a paramedic.

When we accept students who can’t express themselves in the English language, do simple mathematics, or have a rudimentary knowledge of the basic sciences of biology and chemistry, it should be little surprise that the course completion rates and National Registry exam passage rates are abysmal.  It should be little surprise that EMS students are constantly posting questions about examination and certification processes that could be discovered with a simple Google search. And it should be even less of a surprise that EMS doesn’t receive the recognition and respect that other allied health professions earn.

If we want EMS to be treated as a profession, maybe it’s time to enforce some entrance requirements.  Not everyone gets to be an astronaut or a starting NFL quarterback.  Maybe, just maybe, it’s time to say that you don’t get to play doctor in the back of an ambulance unless you have some minimum academic credentials.

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

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

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

(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

Ice Buckets

Posted on August 24, 2014 Written by

As a conservative/libertarian type, I’m in favor of individual charity rather than the enforced charity that the IRS collects every April 15.   As such, any giving to charity should be encouraged and celebrated, both for individual self-worth and the good that charitable giving does for society as a whole.

Having said that, though, the Ice Bucket challenge movement is beginning to annoy me.  It’s the “selfie” of charitable giving.  It’s the self-absorbed “look at me” mentality that seems to infest social media.

The twelfth century Jewish philosopher Maimonides proposed the following ladder of giving:

  1. The lowest: Giving begrudgingly and making the recipient feel disgraced or embarrassed.

  2. Giving cheerfully but giving too little.

  3. Giving cheerfully and adequately but only after being asked.

  4. Giving before being asked.

  5. Giving when you do not know who is the individual benefiting, but the recipient knows your identity.

  6. Giving when you know who is the individual benefiting, but the recipient does not know your identity.

  7. Giving when neither the donor nor the recipient is aware of the other’s identity.

  8. The Highest: Giving money, a loan, your time or whatever else it takes to enable an individual to be self-reliant.

I’ll let you judge where the cold water or ice bucket challenges lie on this ladder, especially “calling out” others for the so-called challenge.

I’m no saint and definitely far from perfect, but I have made a different decision for me.  For me, I’ve chosen to give the gift of my time.  I give my time as a paramedic, volunteering in two different EMS systems.  I give my time (usually freely) as an EMS educator, educating our community about the legal issues involved in prehospital care.  And I’ve lost count as to the numbers of times I’ve spent on the phone or computer providing some quick, informal legal advice to medics, firefighters, or cops.   These are the challenges I’ve chosen to answer on my own, with no towel or recorded message required.

Filed Under: EMS, Rants

Being a Sheepdog

Posted on August 11, 2014 Written by

A good friend of mine who’s a non-practicing paramedic and currently serves as a law enforcement officer out in the Texas Hill Country had a good post on Facebook about the current divide in this country and how it’s also manifesting itself in the divide between law enforcement and the public they serve.

I’d say the gap exists, not just between law enforcement and the community, but between public servants (police, fire, military, and EMS) and the community.  There’s a lot of reasons, I’m sure, but allow me to throw some thoughts out there.

For better or worse, and certainly without ill intentions, we have created a lot of those barriers.  We’ve hidden behind artificially created barriers between “us” and the public we serve.  We cite “homeland security,” “officer safety,” and “HIPAA” as reasons why we no longer engage with the public or create barriers to such engagement.

Several years ago, while on vacation in an unnamed large city known for legalized gambling, buffets, and neon signs, I stopped by their central fire station to get some photos and maybe meet some firefighters and/or medics.   The garage bay doors were closed and there wasn’t even a doorbell to ring.  I walked around to another door and there was a phone to pick up.  When I explained that I was a visiting medic from Texas, I was promptly told that their station wasn’t open to visitors or the public.

Combine that with some communities encrypting all public safety communications (granted, I have ZERO problem with encrypting sensitive channels like SWAT, narcotics, surveillance, etc.) and eliminating ride-alongs, and you’ve created an environment where a communications barrier exists — and where rumor and conspiracy theories can flourish.

Yes, those of us who are public servants are the sheepdogs who protect the sheep.  If anything, that means even MORE of an obligation to be amongst the sheep.

My advice: be approachable.  Let’s be the ones who remind the public that we’re here for them.  Otherwise, as we’ve seen this week near St. Louis, those who reflexively dislike us will have ample opportunity to spread their message.  For better or worse, we live in a constitutional republic and we are servants of the public.  It behooves us to gain and maintain the public’s trust.  One can practice “officer safety,” “scene safety,” or “situational awareness” without coming across as a member of an occupying army.  Take off the wrap-around shades, interact with the public, and show a kid (or even, gasp, an adult) your vehicle.  It’ll keep you safer in the long run.

Ok, rant over, y’all.

Filed Under: EMS, Politics, Rants

Hypocrisy much?

Posted on July 24, 2014 Written by

I read a lot about EMS in a lot of different forums.  And invariably, almost anytime something goes wrong, there’s a debate about “this wouldn’t have happened in my system.”  That’s usually followed by the inevitable debate about what model of EMS delivery to have, whether it’s fire-based, third service, private, hospital, or what have you.

I’ve heard a lot of medics accuse the fire service of wanting to take over EMS.  Heck, I’d even say there’s some validity to those arguments. When modern construction techniques and fire safety codes have dramatically reduced the number of structure fires, you have to have something for the guys and gals at the station house to do.   I’ll also concede that many large city fire departments pay lip service to the EMS mission and have a culture that doesn’t condemn lackluster care.

But ya know what? When you, as a third service, private, or hospital-based medic automatically say that the fire department either can’t or shouldn’t do EMS, aren’t you just the flip-side of the fire chief who says that only the fire service can do EMS?  Like them, you’re dismissing, often arrogantly, the prospect that just because someone wears a certain uniform, that they’re incapable of providing clinically appropriate, compassionated medicine?

What I’ve found in EMS, at least in the USA, is that every community has different needs, different demographics, different politics, and different resources.  The EMS model that Las Vegas uses might not work in rural Kansas.  And probably neither would work in inner city Houston.  That’s the beauty of EMS.  We’re always adapting.

So, as a personal request from your favorite blogger (Oh, wait, I’m not Kelly Grayson!), I’ll ask the fire medics to chill with the “ambulance driver” comments and attitude.  But for those of us whose ambulances aren’t red, we need to drop the “hose jockey” comments and saying that our patient isn’t on fire.

And by chance, if you’re in a system where you have first responders from another agency, take the time to work with them, help train them, and eventually, they might just rise to your expectations.  Canceling them, clearing them from the scene early, or talking down to them only means that they will be utterly and completely incapable of helping when you really, really need that second set of hands on a bad scene.

Just my $0.02 after reading some pretty heated stuff the last couple of days.  At the risk of sounding overly simplistic, we’re all supposed to be on the same team.  Let’s start acting like it.

 

Filed Under: EMS, Rants
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