First off – apologies to my non-EMS readers. I’m going to bitch at my brethren a moment. Feel free to eavesdrop if you’d like.
I fully realize that taking care of surly drunks and crack addicts at 3 am is not what you may have envisioned when you signed on for the job, Little LifeSavers. And while giving a little old lady a ride to the ER to have someone replace her PEG tube may not be a worthy use of your prodigious skills, it IS your job. And if you want to use words like Gomer Tote and Foley Patrol when it’s Just Us Guys, I’ll chuckle right along with you and commiserate. I’ve been there, probably far more often than you have. But if I hear ONE MORE medic refer to a patient in derogatory terms when that patient or a family member is within earshot, I’m going to snatch a knot in somebody’s ass. That applies even when I happen to agree with your opinion of the patient. Be professionals, and maybe one day the rest of the healthcare industry will treat us like professionals.
And when you call in a patient report, have something coherent to say. My colleagues used to wonder at how I got orders from Docs when no one else could, or get away with doing things without orders that would see any other medic get disciplined. It’s very simple: I try very hard not to sound like an idiot when I pick up the phone. Try it some time. You might be surprised.
And here’s another one – no one deserves to be in pain if it can be avoided. And while you may be reluctant to medicate an assumed drug seeker, there always exists the possibility that your assessment and assumptions may be flawed. Look carefully. And when you bring me an eighty year old man WITH AN OBVIOUS FEMUR FRACTURE, he damned well better be medicated. I don’t give a rat’s ass if the nursing home is two minutes away. I don’t care if he fell in my fucking parking lot. Before he is moved from his position on the ground, you had better get an IV and get him some pain relief. The splinting alone is painful enough, let alone the ride to the hospital. We don’t get a chance to save many lives, and there are damned few studies out there that show that a paramedic is any better than an EMT for the average emergency call. But pain relief is something we can do.
On that same note, 99% of EMS protocols were written to ensure that Mongo the Knuckle-Dragging Medic renders the same basic, minimum care as Johnny Gage the Super Medic. If the only justification you can offer for performing a procedure or administering a medication is the phrase, “it’s in the protocol,” guess which one you are? A good medic knows when to deviate from protocol.
Keep this in mind too – strapping someone to a board is not always necessary. In fact, spinal immobilization is rarely necessary. A simple physical examination of the patient is more accurate than a cervical spine x-ray at ruling out a cervical spine fracture. That’s right kiddies, I said more accurate. EMTs throughout Maine do it with great accuracy. If your system requires you to regularly strap some frightened osteoporotic grandma with absolutely no sign of neurological deficits or cervical pain to a hard plastic board, solely because she rolled out of bed, you have two choices: Either blindly do something stupid like Mongo Medic, or call the ER for permission to deviate from your protocols. If that doesn’t work, Google NEXUS some time and look at the studies. Better yet, send me your e-mail addy and I’ll forward a bunch to you. That way you’ll have some ammunition when you pose the question to your medical director, “Why do you write protocols that require us to do painful, unnecessary procedures with no proven medical benefit?”
And if you still have no choice but to immobilize the patient, or in your heart of hearts you feel that he really needs it, for Gawd’s sake do it right. Rob straps from your other boards if you have to, and tear up your membership card in the No Neck Fits Everyone Society.
And here’s another tip – by the time your hyperventilating patient is having carpopedal spasms, their CO2 level has already dropped to the point where re-breathing into a paper bag or an oxygen mask with the flow turned off is pointless. They just aren’t exhaling enough CO2 to re-breathe any. Better to turn the lights down, speak soothingly to them and coach their breathing down to a normal rate, and sedate ’em to the eyeballs if necessary. And no, telling the patient to Cowboy Up does not qualify as coaching.
If you tell me the patient has had a syncopal episode after spewing various gastric fluids from both ends for the past few days, please obtain a set of orthostatic vital signs prior to arrival. That provides us a clue as to why they fainted, boys and girls. It also lets the ER staff know that you have functioning synapses and are thus more worthy of trust than your co-workers. If you give me the eye-roll and world-weary shrug and tell me, “The nursing home got a BP of 70 over Taiwan, but we got a BP of 120/70, chuckle chuckle…” and I wind up finding significant orthostatic changes in vitals…guess what? You just placed your knowledge level directly below that nursing home nurse. How’s that feel, Mongo?
Until next time…