An Open Letter to the EMS Media

Posted on July 2, 2014 Written by

Ambulance Chaser here.  Overall, I’m a huge fan of EMS media, both online and print, and making EMS information available online to our fellow professionals.  However, I’ve noticed a disturbing trend in several of the EMS websites and publication.  The articles related to law and EMS legal issues tend towards sensationalism, inducing panic and fear amongst providers, click-bait, or stirring up business for the attorney writing the article.  Articles on liability tend to report on isolated, extreme cases out of trial court verdicts or settlements, which do not create binding law anywhere.  And more than one article has ended with information about how to contact the attorney-author for more solutions to the problem they happen to be writing about.  And we know that HIPAA and privacy issues are routinely invoked as bogeymen waiting to trap unsuspecting EMS providers, when we all know that realistic common-sense measures address most compliance issues.  But that doesn’t drive up “clicks” on the website nor clients to the lawyers to purchase a tailor-made compliance handbook and checklist.

And let’s not even talk about the constantly invoked specter of losing your license, getting sued, or gasp, going to jail.  Yes, EMS provider liability exists.  (Honestly, in my opinion, I think more providers should be sued for some of their acts.)  But the liability for EMS providers and EMS systems is a creature of state law in the overwhelming majority of cases.  Continually citing an attorney who practices in one of the worst possible states for tort liability is at best, fear mongering, and at worst, disingenuous.  It’s as self-interested as for a CPAP vendor to write an article on how and when to use CPAP.  Heck, most of the publications put that kind of obvious infomercial in a “special supplement” to the magazine.

And heck, we’re ignoring several of the big issues in the legal arena that continually “bite” EMS — wage and hour claims, employment discrimination claims, tort liability for vehicle operations, and compliance with state administrative regulations.  But of course, it’s much “sexier” to write about some case where some medic in West Cornfield got sued because of a bad outcome for the patient.  Posting an article like that, of course, brings out the legal experts who populate Facebook and social media.  And that drives up the clicks on the website.

For EMS to progress, we are going to have to develop our own core of “experts” in fields related to EMS, including law, politics, and policy.  At the risk of sounding exceedingly self-interested, I believe I fit into that role.  I am one of the few attorneys who’s actively practicing both law and paramedicine.  I bring a focus on addressing and managing risk to legal issues, including those in EMS.  Additionally, with much of my career being in state government, I have a real understanding of the political, regulatory, and advocacy processes that many in EMS do not possess. (If you’ve read my blog in the past, you know my thoughts on what’s right and wrong on our efforts at advocacy and politics.)

I’m not asking for a column or a position (although I’d certainly be open to it).  What I would respectfully request as an reader as well as a practicing EMS provider is that we demand the same excellence in media addressing EMS legal issues as we would clinical issues.

Sorry for what seems like a more self-interested post than usual, but, to a large extent, what the EMS media is publishing as legal education is just not what most providers need.

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

Progressive tension

Posted on May 30, 2014 Written by

Most of the time, I try to stay out of politics here, except for EMS politics.  Today, I digress into international politics and religion.  Why?  Because I’m calling out hypocrisy.  If you don’t like my views, that’s ok too.   Google “cute kitten pictures” and come back when I’m blogging on a medical issue again.

Today, I’m calling out the progressive community.  On some issues, I agree with them, especially regarding individual freedoms.   Want to open up a casino that performs gay marriages and has a women’s health clinic that additionally distributes marijuana on site?  Go for it!  Having said that, don’t expect me to subsidize it with my tax money.

But here’s the hypocrisy of the modern left.  By and large, the modern left embraces cultural relativism and multiculturalism.  That’s well and good to be tolerant.  But tolerance is a Western value.  A lot of other cultures don’t embrace tolerance.  Tolerance to them is that you submit to their ideologies and beliefs.

Over the past month, terrorists have kidnapped 200 Nigerian schoolgirls for getting a Western education, a Sudanese woman has been condemned to death for abandoning the faith of her father to become Christian, and several honor killings have been publicized in Pakistan.  George Takei has publicized the plight of the woman in Sudan and no less than the First Lady of the United States, Michelle Obama has tweeted “#BringBackOurGirls” in response to the Nigerian kidnappings.  (Personally, I think a visit from SEAL Team 6 and/or the British Special Air Service would go a long ways toward bringing those girls back.)

For years, mostly conservatives and secular European libertarians have been pointing out that Islam does not always share our Western values, in particular many of the values that the progressive left claims to value such as freedom of religion, secular government, and women’s rights. What did the Left tell those Cassandras who warned us of the intolerance of politicized, radicalized Islam?  Why, Islamophobia of course.

Of course, the minute the Nigerian girls were kidnapped by an Islamic terrorist group whose name literally means “Western education is wrong,” the progressive movement had to say something.  After all, feminism is a core tenet of the modern left.  And at that point, the warning and condemnations came out.  Why, Jay Leno’s wife even came out against sharia (Islamic) law.  Previously, the left described warnings against sharia as Islamophobia from the Tea Party and chuckled a smug, knowing laugh.  (You know, think Bill Maher, Stephen Colbert, or Jon Stewart.)

Tolerance is a virtue (as the old saw goes), but tolerating and granting moral equivalence to a culture and belief system that is diametrically and violently opposed to your own ceases to become tolerance.  Rather, it becomes a suicide pact.   To my liberal friends who wish to appease the barbarians at the gate, don’t think that the wolf won’t eat you.  The wolf may just eat you last.

Filed Under: Politics, Rants

EMS Week Resolution

Posted on May 21, 2014 Written by

So, it’s EMS Week.  Hopefully, by now, you’ve gotten your free cafeteria meal and/or slices of Little Caesar’s pizza from your local hospital, assuming the nurses didn’t eat it before you got there.  You might’ve even gotten a t-shirt or some other motivational knickknack. It probably has some inspirational saying and lots of Stars of Life festooned all over it. After all, you’re a lifesaver.  You race the reaper.  You’re special, dammit!

Ok, time for us to take a minute and grow up.  I mean, for real.  Last night, I got involved in an online discussion about EMS providers in an unnamed state (let’s call it the Keystone State, for the sake of this discussion) being required to retake the National Registry if they were even a half hour short on continuing education.

Gasp.  Horror.  OHMYGOD — ZOMBIE APOCALYPSE!  How dare these people be held accountable?  We’re always saying EMS doesn’t get trust or respect from the rest of the healthcare and public safety world.  Why?  Because we don’t want accountability.  Whether or not you like the rule, it’s there.  And if you’re a professional, you have to take responsibility for maintaining your certification.  And yes, that includes taking the initiative to maintain and keep up your continuing education hours.  No one else, other than you, has that obligation to yourself.  In other words, if you want to maintain the ability to feed yourself as an EMT or a paramedic, you’ve gotta get the CE hours.  No way around it.

So, when everyone finally realizes that’s part of the deal to being a medic, then the argument comes out that no other healthcare providers have to take the licensing exam again if they don’t have their CE hours.  Whose fault is that?  It’s ours.

But how is it our fault?  Quite simply, we’ve given up (and probably never had) any semblance of being interested in or capable of self-regulation.  How many EMS people know how their state’s EMS legal and regulatory framework is set up?  Know where to find your state EMS Act?  Know where to find the physician licensing statutes?  (Because that’s probably got the information about what and how a physician can delegate practice to EMS providers.)  Know where your state’s EMS administrative rules are?

Ok, do you know how these things are created?  Can you describe how a bill becomes a law in your state legislature?  Can you describe how an administrative rule or regulation is adopted in your state?  Know what a public comment period is?  Know how to file a public comment?

If you don’t know, or worse yet, if you don’t care — you are why EMS is held back.  I will guarantee you that part of why nurses have the power in the healthcare world is because nurses are organized.  They fight like hell to maintain their own professional regulation.  They have state nursing associations to fight at the state capitol and to tangle with bureaucrats and regulators.  And as such, they, along with physicians, dentists, and even lawyers have their own professional regulatory boards.  And these boards, wait for it — they’re largely made up of the professionals that they’re licensing and regulating.  Us?  Most states don’t have an EMS regulatory board.  We’re slammed into the state health and human services bureaucracy right there with the tanning salons, tattoo parlors, and giving immunizations and running mental hospitals.  No wonder we’re neglected.

It’s a lot more fun to bash lawyers.  But good administrative lawyers who can deal with the regulatory machine and lobbyists who know the state legislative process are what EMS needs to advance.  Where’s EMS at the state capitol?  Not present, except for maybe a congratulatory resolution during EMS Week.  It’s the political version of Miss Congeniality or “everyone gets a trophy.”

Meanwhile, our national EMS association that claims to be the voice of EMS continues to tilt at windmills at the Federal level and think that passing the so-called Field EMS Bill and its grant funding mechanism will fix EMS.  Nope.  Not hardly.

What will fix EMS is when we grow up, demand self-regulation as profession, and grow the political skills to make it happen — and then keep it.

Let’s make EMS Week 2014 the point at which EMS grows up and becomes a profession.  But first, grab that last slice of Canadian bacon and olive pizza before Tina from Radiology gets it.

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

Discussion fodder

Posted on May 15, 2014 Written by

I was recently discussing the role of EMS with a surgeon friend of mine and we ended up discussing the beauty of the radio/cell phone patient report versus the handoff at the hospital.  Like many providers, I’ve had instances where nursing staff demands information from me or demands that I take a set of vital signs for them on the hospital’s equipment.  Combine that with some of the nursing discussions about nurses considering EMS to be “unlicensed personnel” that can’t be delegated tasks and you’ll get the spirit of the rant I’m sharing with y’all for discussion fodder.

 

At some point, the physicians need to step up, put the nurses in their places, and remind them that EMS providers work under a physician’s delegation, and don’t work for (and aren’t subordinate to) nursing staff.

 

I am working on another, longer post soon. In the meanwhile, though, I wanted to get some discussion going about the role and place of EMS.  And a controversial, blunt post seems to be the way to drive up the readership….

Filed Under: EMS, EMS 2.0, Rants

Paramedicine. The challenge.

Posted on May 8, 2014 Written by

I’ve been reading some comments on my blog today.  The commenter is also an EMS blogger.  He happens to be an EMT who’s currently back in school to become a physician’s assistant.  He and I have been engaging in a bit of a debate about the role of BLS versus ALS in prehospital care. From my reading (and we all know how perception and tone sometimes get lost on the Internet), he’s one of the people who believes that good BLS care is the critical component of any EMS system.  I respectfully say there’s more to being a good provider than good BLS care.  I also assert that there’s more to an EMS system than good BLS care or good cardiac arrest survival stats.

I’m not one of those types who likes the shopworn EMS t-shirt slogans like “BLS before ALS,” “Paramedics save lives and EMTs save paramedics,” or the all-time classic, “Do you want to talk to the paramedic in charge or the EMT who knows what’s going on?”   First of all, the BLS versus ALS dichotomy, seems to me, to be another example of the inherent bias against education and professional advancement in EMS.  That, somehow, the core principles that an instructor tries to convey via “Death By PowerPoint” in a 120-160 hour training class are the only things that matter in emergency medicine and that it’s admirable, nay, even noble to focus solely on this limited set of medical knowledge.  The “low information voter” of these types claims that’s all they need to know.  The sophomoric (Greek for “wise fool”) EMT advocate claims that the science and studies show that advanced life support care doesn’t make a difference.  The science and studies may provide proof of this conjecture for cardiac arrest care, but that’s the low-hanging fruit of studies for out-of-hospital medicine.  Dead or not dead.  But that’s defining EMS success based on a very small subset of our calls — salvageable patients in cardiac arrest.  (And for success there, we’re better off just putting AEDs in public places and mandating CPR training for the public.)

For better or worse, like much of medicine, what we do isn’t easily quantified into a study.  How can you measure the pain you took away from an elderly patient with a hip fracture that you administered Fentanyl to prior to moving them?  How do you measure the symptom relief you provided to a congestive heart failure patient with CPAP and nitroglycerin?  These anecdotal differences are why medicine remains a learned profession that cannot be distilled into a mere science.  Science gives us the information and knowledge to provide care to another.

Being a paramedic is a mindset.  It’s possessing the full armament of prehospital knowledge.  It’s knowing when to use, and more importantly, not use an intervention.  It’s using the resources you have on scene.  It’s knowing when you need additional resources.  It’s managing your partner, regardless of their certification level. It may even be calling a doctor for a consult or orders.  Most notably, it’s a set of skills, knowledge, and competencies that can’t be learned in a 120-160 hour course.  Heck, in my personal, non-researched opinion, graduating from paramedic school makes you only competent enough to spend the next year or so in a high volume, high acuity EMS system honing your abilities and skills under the tutelage of a mentor.  Nope.  Not a FTO.  Field training is merely orienting the provider to a particular EMS system.  You need the mentorship to learn the craft of being the highest level of care outside of a clinical setting. Paramedic education teaches the fundamental knowledge and skills.  Tutelage under a mentor makes you a master at the job.  It’s the difference between knowing how to perform a rapid sequence intubation and looking at a patient and realizing that they’re in danger of losing their airway.

Paramedicine, or prehospital care, is like all of medicine, more than mere science. It’s the application of scientific knowledge to real people.  And the world of paramedicine adds in the confounding factor of applying this knowledge to people in the nonclinical setting.  The choreography of EMS is the challenge.  Until you’ve picked up the baton as the lead paramedic to conduct the prehospital symphony of your partner, first responders, firefighters, cops, the patient, and hysterical bystanders/family, you’ll never understand the challenge — nor can you understand the sheer joy of it.  If you’re an EMT, pick up the challenge and advance professionally.  Otherwise, I will politely and respectfully ask you to defer to my prerogatives as the lead.  That doesn’t mean that we can’t discuss patient care. It doesn’t even mean that I don’t want to hear your ideas on scene.  What it does mean is that we’re not in a democracy and that with my increased knowledge and responsibility comes the decision making authority.

Thanks for reading, y’all.

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

Endangered Species

Posted on April 15, 2014 Written by

So, I recently read an article online in Fire Apparatus Magazine bemoaning the state of EMS. Because, as we all know, the most current information on emergency medicine comes from a magazine that shows pictures of big red shiny trucks.

When you go through the article (I’m not going to link it because I don’t want to give this guy any more legitimacy), he raises the standard argument that fire chiefs and large EMS system managers always use as their stalking horse in their arguments to keep EMS educational standards low — or even lower them. Yep, that’s right. The mythical rural EMS volunteer who will disappear if we change the science and/or add one more bit of knowledge to their already overflowing brain.

I feel more than qualified to address this issue. I’ve spent the majority of my EMS career as a volunteer at both the EMT and paramedic levels with both fire-based systems and third service models. I’ve worked urban, suburban, and rural. The majority of my experience has been in combination departments where paid and volunteer medics work side-by-side. And to the premise of this article, I say, “BULL.” Well, I said more, but this is a family-friendly blog.

I’m more than tired of using the overworked rural volunteer provider as a straw man. First, regardless of whether you draw a paycheck or not, an EMT or paramedic certification is the same. In many states, you can’t say the same for a paid versus unpaid firefighter. Second, in my experience, volunteers are some of the most motivated people out there when it comes to seeking continuing education and opportunities to advance their medicine. In the rural service where I currently volunteer, we have an active continuing education program consisting of monthly online classes as well as a full panoply of “card courses” covering resuscitation, cardiac care, medicine, trauma, pediatrics, and tactical medicine. Our medics, at all levels, routinely exceed state mandated training requirements. I’d further note that several of our paramedics are volunteers who work in outside professions and maintain licensure in those professions as well. Furthermore, come to any of the big EMS conferences. There, you’ll notice a disproportionate number of volunteer providers, especially compared to those employed in large EMS systems.

In short, Chief Haddon of the North Fork, Idaho Fire Department is wrong. Volunteer EMS providers can, will, and do exceed educational requirements and expectations. Give them a chance and you’ll find out. And if you don’t believe me, I’m extending a personal invitation to come down to Texas. I’d be happy to introduce you to some volunteers who actively seek to improve themselves professionally for the benefit of their patient. Heck, I’ll even treat to BBQ.

I’m not expecting a visit, though. It’s a lot easier to use the myth of the overworked, overwhelmed volunteer EMS provider who will go away if we add one more class. Sadly, this “don’t need to know it mentality” usually only benefits the “mongo mentality” of “you call, we haul” that seems to hold back EMS. The worst part is that the same departments and administrators who bemoan increased EMS education can be seen at all of the structural fire conferences. Maybe its time to have more volunteer EMS systems and less volunteer fire systems?

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

Heresy in a paragraph (or less)

Posted on April 14, 2014 Written by

A few years ago, the formerly ALS skill pushed to the masses was the Epi-Pen.  Now, it’s Narcan.  What’s different?  Simple.  Narcan is going to be needed less in the field but will probably be used more. What would work is teaching people how to properly ventilate with a BVM.  It fixes the real problem (depressed respiration) and has more uses than just an opiate overdose.  But why should we teach BVM skills?  After all, it’s barely taught properly to EMS types.

And let the heresy accusations begin.  At least I didn’t bring up backboards.  Yet.

Filed Under: EMS, Rants

Observations from Facebook Friday

Posted on April 4, 2014 Written by

Spent some time actually observing and digesting some EMS stuff on Facebook today.  Two random thoughts.

1) Less than a few moments ago, I watched my Facebook feed roll by with another NAEMT post shilling the “Field EMS Bill.” Tell me how making sure EMS ends up in the Federal HHS bureaucracy (ya know, the same people implementing ObamaCare) and creating a pool of grants for “innovative” EMS projects (read: politically connected EMS systems that already get plenty of national attention and funding) does a thing for the field EMS provider? I’d much rather the NAEMT powers-that-be working on true certification reciprocity.

2) I also observed a post about palliative care and DNRs that was shared from one of groups that I’d identify as catering to the so-called “low information voters” of EMS.   The ambulance drivers on that group (yep, if you act like Mongo the Gorilla, I’ll call you an ambulance driver) asked if a transfer patient had a DNR.  The nurse replied that the patient had “comfort measures only.”  The ambulance drivers said “full code then.”  I can’t understand some people in EMS.  They want a simple cookbook of recipes to follow, along the lines of “If A, then B.”   But when people call them ambulance drivers, they claim to be offended medical professionals.  Nope.  You’re an ambulance driver.  Professionals don’t define themselves by a skill set (witness the paramedic intubation debate) and exercise some freaking judgment.   Have a banana, Mongo.

Filed Under: EMS, EMS 2.0, Rants

Toxic exposure

Posted on March 13, 2014 Written by

Some of my EMS friends refer to the less enlightened of us in EMS as LIV, shorthand for Low Information Voters.  I’m the first to admit that I like the term and use it.  Sadly, I have occasion to use it regularly, especially seeing what some providers post publicly on Facebook.

After some thinking this morning about a couple of discussions I’ve been watching, some LIV providers scare me more than others.  The youthful, overly eager provider who has maxed out their credit line at Galls by buying every piece of equipment known to mankind has the potential to be a diamond in the rough. Those of us who consider prehospital care to be part of medicine owe it to ourselves and our patients to channel said youthful enthusiasm into the art and science of patient care.

Then there’s the other form of LIV.   The so-called “experienced” provider whose only contributions are mindless repetitions of bad information, usually associated with withholding pain medications to those they deem unworthy of their skills.  These older LIVs are also usually the first to scream about the good old days and shame anyone who doesn’t conform to their limited understanding of medicine and operations.  To quote Spiro T. Agnew, these people are the “nattering nabobs of negativism” of EMS.  Their pessimism is toxic, both to other providers and to the advancement of prehospital medicine.

These old-timers run off enthusiastic providers, stagnate development, and generally make work a crappy place.  Their toxicity runs off others and infects the workplace as surely as an outbreak of norovirus.  Heck, at least norovirus runs its course and leaves.  Yet for some reason, these cranky ones are only happy when they can actively discourage others.

Please, if you actively embrace terms like toasted or burnt out, step away from patient care, whether for a sabbatical or permanently.  You owe it to your coworkers and your patients.

 

 

 

 

 

 

 

 

Filed Under: EMS, Rants

What’s our paradigm?

Posted on February 28, 2014 Written by

Fair warning.  I’m going to offend a lot of you.  Hell, I’m expecting a nasty snarky reply or two.

I love the public safety aspects of being a paramedic.  I admit it, I’m enough of a sparky type that I like having a utility belt. I love my duty boots, my radio (which, yes, I leave on “scan”), the 5.11 pants, and the really cool windbreaker with my department patch and my Texas paramedic patch.

Here’s what I don’t love about the public safety paradigm.  The paranoia. The “us versus them” mentality. The culture of fear.  The constant “street survival” mentality.  The belief that every call may be our last.

Now what about medicine?   That model has some flaws too.  So many of us idolize Dr. House and his approach.  You know the mindset.  Nevermind being nice so long as you nail the obscure diagnosis. And it’s never lupus.

Minions, we’re EMS. We adapt.  We adopt the best from every discipline.  It’s time to start living that.  Yes, the public safety mindset protects us,  but it shouldn’t make us paranoid wannabe state troopers.  Yes, we practice medicine (and even diagnose), but it’s not a substitute for warmth.

Whether or not we like it, we are an amalgamation of several different professional disciplines.  I like to say that we practice operational medicine — we deliver acute and urgent care medicine at a mid-level scope using aspects of the public safety professions to help us deliver that care.

In summation, never let being either a clinician or a public safety provider detract you from the main mission — being a caregiver to all of our patients. And yes, the family, friends, and bystanders are part of the care continuum, y’all.

Have a great Friday and an even better weekend.

 

 

Filed Under: EMS, EMS 2.0, Rants
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