The EMS Blogosphere is current alight with a discussion of the dreaded phrase “ambulance driver.” Alternatively, I call today Wednesday. We’ve got Captain Chair Confessions, EMS Outside Agitator, Medic 51, Ambulance Driver, and The Social Medic all weighing in on the phrase. So, now that we’ve cured cancer, I guess we can get to some important issues like making sure the public doesn’t call EMS providers “ambulance drivers.”
Wait, what’s that? There’s still no cure for cancer? Oops.
I’ll be the first to say that language and word choice is important. It defines debates. It reveals a lot about the person speaking. There’s no debate that word choice is important and that we need to control the words used to describe our burgeoning profession. However, there is a time and a place for discussing the words that -other- people use (we can always control our language), and there are simply much more pressing issues. Heck, us controlling our field in a way that contributes to controlling the public’s word choices was my very first blog post.
However, think about the following things.
Imagine if EMS providers took this much interest in discussing the poor state of EMS education.
Imagine if EMS providers took this much interest in discussing the issues facing reimbursement for the services that EMS provides (including removing the transport requirement).
Imagine if EMS providers took this much interest in developing EMS research.
Imagine if EMS providers took this much interest in developing systems to prevent calls.
Imagine if EMS providers took this much interest in tackling any of the vastly more important issues rather than being called an “ambulance driver.”
Imagine if EMS providers put as much interest into making EMS into a profession (instead of the current “profession in name only” situation) that we currently do complaining about the term “ambulance driver.” We might actually get something done.
Since I can’t avoid getting on an image meme bandwagon and working on my MS Paint skills, here’s my “What We Do” image. Also, I promise more serious and useful content soon.
One of the forums I frequent recently had a poster ask a question about the mechanics of breathing, so I made the following based on a model that was used in a grad school physiology lecture. However, that model was a professionally manufactured model. Hopefully it’ll give new providers that “Aha” moment when covering respiratory physiology. On a quick technical note, the last two ribs (11 and 12) move in a “caliper motion,” which is simply out and in, unlike pump handle or bucket handle ribs.
In case you haven’t heard yet, California is working towards officially introducing (pdf) (underlined is new legislation. Some of it is cleaning up a mess left from moving EMT-II to AEMT) Advanced Practice Paramedics and Critical Care Paramedics as state levels. While scanning over the proposed legislation, the following line from the proposed Critical Care Paramedic scope of practice struck me as odd.
“1. perform digital and nasotracheal intubation;” -pg 11
Wait, shouldn’t the scope of practice (albeit the basic scope of practice for all paramedics) be “intubation?” If paramedicine is a profession, shouldn’t paramedics be entrusted with the independent judgement to determine, based on their education, training, experience, available tools, and their assessment of the patient, how specifically they intubate? If a paramedic believes that the totality situation calls for digital intubation or a gum bougie or any of the other method instead of or supplemental to direct laryngoscopy, shouldn’t that be the imperative of the professional paramedic? Furthermore, provided standard concerns are met like maintaining oxygenation, isn’t the goal of putting an appropriately sized tube into the slightly larger (and correct) tube, and the ensuing confirmation, more important than how that is achieved?
Could some of the issues with paramedics intubating be, in part, because the wrong tools are being used? If you only have a hammer, then everything is a nail. That’s fine, provided you’re dealing with nails or wooden pegs. However when you get to screws, sure a hammer may work, but why not use a screw driver?
Why is the skill of direct laryngoscopy more important and sacred than the intervention of intubation when other skills can achieve the same goal? Furthermore, if paramedics cannot be trusted to pick the correct mechanical skill when providing the intervention of intubation, what does that say about paramedics, and why are paramedics not fighting back?
On a side note, I’m sure I’ll have more than one person think I’m a complete idiot for this, and the ensuing implication about EMS’s current status between technical trade and profession. Feel free to call me an idiot in the comment section (or email, but the comment section lets you drive the discussion), I don’t mind and without discussion nothing changes. My only request is that you take a minute to call me an idiot, take a second minute to explain why I’m an idiot.
The first video is from July and came to my attention though Statter911 (the comment section includes responses from the camera man). The second video came to my attention today through the JEMS Facebook page, and neither paints EMS is a good light.
First, I agree that access to active scenes needs to be controlled, and preferably with some sort of barrier. Similarly, I agree that fire, EMS, and the police have a responsibility to ensure that non-responders are not in dangerous areas and are not interfering with the response. Finally, I agree that EMS has a duty to protect a patient’s privacy, albeit done by the crew taking positive action on their part, not by restricting what people in public can film.
Having said that, requesting the press to leave a scene needs to be done carefully unless they are actively interfering with care or in a truly dangerous location, and force is an option of last resort. From what I can see, neither is the case in either of these cases, and before anyone starts talking about hazmat in the second video, how many other people are walking around in street clothes? Claiming scene safety is rather hard to justify with so many other people wearing no protective equipment in the immediate area.
Similarly, interfering with the scene is dubious, especially with no boundary tape up. Simply being on film is not interference. Someone getting upset and being distracted because someone an appropriate distance away is filming is not being interfered with. If you can’t handle the pressures of a job done in public, and relatively often done in situations of public interest (in contrast to most other careers), emergency services is the wrong set of careers to be involved with.
More importantly, unless it is a matter of object life or death for the camera man, it is simply not worth the fight with someone who is not interfering with the scene. Regardless of the ultimate judgment of either of the above cases, the EMS provider and service loses. It’s a lot like crossing a busy street at an unprotected cross walk without looking both ways. Sure, the cars should stop for a pedestrian in the cross walk, but when the car going 30 mph runs into the pedestrian, the pedestrian loses. Similarly, while the EMS provider may be “right” in his or her ability to control access to a reasonable area around an incident, the damage done by making the 4, 5, 6, and 11 o’clock news, Statter911, and the JEMS Facebook page simply isn’t worth a physical battle in the vast majority of cases.
However, there are generally plenty of options that should be run through before coming to blows with reporters.
Approach the videographer is a professional manner. Make them your ally. Politely state your concerns, request compliance, and offer alternatives. As with dealing with everyone else a, “Hi, I’m concerned about my patient’s privacy, would you be willing to blur the patient’s face prior to broadcasting the video?” works better than “Stop filming!”
A “Would you mind filming from over there that’s out of our way?” works better than, “I told you to stop filming.”
If worse comes to worse and you have to ‘make’ a videographer leave, then take a lesson from Major League Baseball umpires in how to diffuse and walk someone away. If you have enough people to send someone over to eject the videographer, then you have enough people to do it in a manner that won’t end up on the 11 o’clock Action News broadcast.
While I’m all for a ‘stay and play’ mindset for the vast majority of patients, if worse comes to worse on an EMS scene, move the patient to the ambulance. You have to do it eventually and the ambulance comes with a built-in perimeter.
Finally, if you absolutely have no other option but to lay hands on a reporter, engage the police first.
Above all else, when dealing with someone who can tell a story to millions of people, choose your battles wisely. If the story is going to be about the providers, let it be about your medical care, not your fight with the man with the camera.
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