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.

Image from: http://below100.com/

How to make the model.

(Original artist is unknown)

The mental image of Stripper Stalin alone should be enough of a mental image to spur good grammar from anyone.

“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.

Friday; wrap up day with another set of great sessions. My only scheduling complaint (besides having so many good sessions overlapping, making for some hard decisions over the 3 day expo), is the entire 2 sessions, lunch/exhibit hall break, 1 session, go home. Unfortunately, I made the decision to leave during lunch, which was ultimately a bad decision since my route home was blocked with a brush fire. Personally, I’d rather have all three sessions together or a late start, 1 session, lunch, 2 sessions. C’est la vie.

My first session of the day ultimately should have been a capstone presentation. Justin Schorr (of The Happy Medic fame) presentation on infiltrating command was a perfect wrap up for the expo. With so many of the sessions revolving around the cutting edge or inevitable evolution of EMS, what good is the information if it never reaches the people who can affect change? More importantly, why can’t (and ultimately why aren’t) you, the individual provider, the agent of change? Research new protocol options or changes. Offer to help set up or run that new program. Become the service expert in some aspect, and then utilize that knowledge and respect to help bring about change. Ultimately the front line providers and supervisors underestimates the power they have if only they were willing to roll up his sleeves and get their hands dirty.

My next session was the Gathering of Eagles conference, which was another great roundup of the current controversies and direction of research in EMS. One of the nicest features of this was how open the session was run. Essentially the discussion was open to what the attendees wanted to discuss. However, like a lot of the research talks, it boils down to a lot of what we do lacks evidence (lack of evidence isn’t the same as evidence of harm), and a lot of interventions might not matter whether it was initiated prehospitally or at the ED. However, EMS is also pushing the EDs to implement new interventions.

On the exhibit hall front, there was a few products that stood out. To be honest, I’m not really big on having the newest shiny toy. I’ll take a standardized patient and proper clinical rotations over a $50k simulator, give me switches instead of touch screens in the ambulance, and I honestly don’t care about portable suctions provided they, well, suck (and don’t get me started on the backboards). However a few products did stand out.

SynDaver Labs

Probably the booth that wowed me the most was the SynDaver booth. Requiring a good foundation in anatomy and physiology is one of my pet peeves, and ideally the anatomy course would be a gross anatomy course. For a variety of reasons, cadaver labs aren’t the easiest to get into. This is where the SynDaver comes into play as an anatomy simulator. There’s a difference between being able to feel, cut, and see actual organs and simply reading about them in a book, including the so-called “Dead Body Book.” To that end, I think that the SynDaver products fills the gap between an anatomy atlas and a cadaver lab rather well.

Ferno Mondial

Technically, this wasn’t a booth but the gurney from one of the ambulance manufacturer displays. There’s some sort beautiful simplicity that comes with combining a pole stretcher with an ambulance gurney. Going off of appearances (this is one of the few toys that I wouldn’t mind having a chance to truly play with), it looks like it gives crews a better choice and access to tools need to move patients over either rough terrain or tight spaces. It’s a better option than, say, putting a transfer flat (another under utilized piece of equipment) under the gurney mattress.

As a final note, thinking back to the topics and the conversations, one thing I’m thankful for is the topics, the bluntness, and the level of discussion maintained during the conference. As a veteran of EMS discussion sites online over the past several years (before the rise of EMS 2.0, JEMS Connect, or the EMS Blog-o-sphere), I know the hot button topics. I know which comments will bring out frothing hatred not because the message is wrong or because the poster is “trolling,” but because of how personal some people take EMS. So to hear one of the presenters state that EMS in the United States is still trying to recover from the harm of the 1993 EMT-B curriculum was shocking. Not because it was news to me. Not because I disagree, either on an intellectual level or a personal level as an EMT, but because I know what sort of fire can come with comments like that. It was shocking to finally be with a group of people who have a similar view-point and who are largely dissatisfied with the current general direction of EMS and are doing their best, in their own way, to help put EMS on the right track.

]]> https://emtmedicalstudent.wordpress.com/2011/09/09/ems-expo-wrapup/feed/ 1 spaczkow EMS World Expo IMG_0083 IMG_0080 IMG_0079 Ferno Gurney https://emtmedicalstudent.wordpress.com/2011/09/02/ems-world-expo-day-2/ https://emtmedicalstudent.wordpress.com/2011/09/02/ems-world-expo-day-2/#comments Fri, 02 Sep 2011 08:01:57 +0000 Joe Paczkowski http://emtmedicalstudent.wordpress.com/?p=229 Continue reading →]]> Another day, another set of great sessions. Granted, I’m generally playing in the dry area of the Admin and Educator tracts, but hey, I’m kinda of weird that way. The Community Paramedicine 101 session had an interesting overview of both systems that currently utilize community paramedics to differing degrees, as well as they’re effects and ways to fund them (again, more than slightly important if EMS is more than a quick ride to the hospital). Granted, that position isn’t for everyone, if you could return 11,000 bed hours back to the local hospitals (…and I can’t remember which system that was for the life of me), the efficiency added to the system alone is going to be worth something, if only by reduced wait times and hospital diversions.

The other session that would be ground breaking if (when?) implemented was the discussion in Do Your Protocols Penalize Your Best Paramedics? Even the concept of being able to tailor, on an official level, protocol restrictions to the provider has a huge opportunity both to revolutionize patient care, as well as the profession itself. Imagine the consequences if the protocol was a floor instead of a ceiling crawl space? All of a sudden all of those courses that don’t matter because “we’re not physicians or nurses” matters a great deal. Continuing education all of a sudden becomes pertinent (Side note, what’s the point of continuing education if you can’t actually implicate what you learned? After all, you’re being compared to Tommy, who couldn’t form a proper treatment plan with both hands, a map, and a cookbook protocol book who hasn’t taken that CE) because you’re expected to be different. All of a sudden knowing all of that anatomy, physiology, pathophysiology, etc becomes pertinent because the minimum standard is no longer the maximum standard.

Probably the most important thing is a potential end to the EMS brain drain. How many paramedics and EMTs are lost every year to medical schools, nursing schools, PA schools, or other professions? Sure, pay is an issue, but so is how restrictive some systems are when it comes to treatments or required medical control contacts. It doesn’t matter what the pay is when certain aspects of your job makes you hate it, such as an inability to use independent judgement (not to be confused with independent practice). After all, imagine how different EMS would be if the paramedics who left were the paramedics running EMS, both in the government regulatory agencies, as clinical managers, and as training/QI? Imagine how much easier it would be to implement community paramedics if you have a whole gaggle more of paramedics ready and willing to take on that challenge. Instead, they’re now the RN/PA/MD because the system essentially pushed them out.
Finally, I’d like to put 2 pleas out there. Sure, it’s 12:45 am on the last day of the conference, but if by some feat of magic or witchcraft (besides turning me into a newt*), please participate. First, ask questions. If the presentation asks for comments from the peanut gallery, raise your hand. You never know who’s going to say what that’s going to effect the direction of the conversation or influence someone else. At worse, you’re wrong (which is great because misunderstandings or mistakes happen, but not catching and fixing them is inexcusable), at best you’ve provided a kernel that may fundamentally change the conversation or how someone else interprets what’s being said. Your comment might get someone else thinking along the same lines, which eventually produces a refined and usable concept. Evolution is not a closed system.

Second, go and talk to the equipment manufacturers in the exhibit hall. Go sit in the ambulances, push the buttons, AND PROVIDE FEEDBACK. The manufactures can’t fix what they don’t know is broken. Sure, they have their focus groups of both managers and field providers giving them feedback, but here’s a chance for you to interact personally. Share what works. Share what doesn’t (Dear Wheeled Coach, do us all a favor and just make the “Patient heat/cool” HVAC switch in the back a standard feature). Many of the ambulance manufactures are going to LCD panes to control everything. How does using a touch screen, in contrast to mechanical switches, affect the driver’s ability to concentrate on the road? Sure, most of us have absolutely nothing to do with buying equipment, but we have to live with their choices, be it the ambulance or the monitor or the backboards. However, who ever does equipment and vehicle acquisitions can’t buy a vehicle with a feature that hasn’t been implemented or a “feature” that hasn’t been removed yet. The ambulance is your office, and everything else is your tools. You have a chance to speak one on one with sales and executives from many of these companies. Don’t squander it.

*I got better.

First off, 5 hours of sleep combined followed by 2 hours of class, 3 hours of driving continuously, while going from 50% humidity to 3% is a good recipe for being tried and very dehydrated. Also, a spaced out feeling isn’t good when meeting new people.

Next, apparently people in EMS really don’t care about how much they get paid. The EMS on the Hill: What’s Congress up to? had really light attendance, and with Medicare being one of the primary payers for EMS transports, Congress is just slightly an important entity. Also, how many people know about the Field EMS bill that’s currently trying to make it’s way through Congress? Funding for grants, equipment, research, and actually trying to get Medicare to pay for all of the cost for transports instead of significantly less are rather important things.

On the exhibit side, there’s a few interesting product exhibits, tons of ambulances (and plenty, thankfully, with 4 point restraints in the back), and entirely too many booths portable suctions and backboards. Pictures to come tomorrow (when I don’t leave my camera in my car).