Not Again Rant

Two back to back calls to start the day. Nothing exciting. Routine ALS. A COPDer with belly pain and a possible TIA already resolved.

Came back, got on the internet, and did my daily morning surfing.

Boston Globe Red Sox Coverage

Boston Dirt Dogs

Marketwatch

Then I checked on fellow EMS blogger

the macmedic

His posting called my attention to an incident I hadn't heard about so I looked it up on the web.

State Investigating EMTs' Response To Lightning Strike


Bottom Line: A 48-year old man gets hit by lightning. His friend does CPR. A basic ambulance arrives. The EMTs stop the CPR and call the patient dead. They don't talk to medical control. They cancel the responding paramedics. They put a blanket over the patient. Ten minutes later, the patient is spotted by a police officer apparently breathing. Patient is alive with palpable pulse. Rushed to hospital. Patient is now in critical condition. State investigates.

I echo the macmedic's concerns that once again we all look like idiots because some members of our profession don't follow presumption of death protocols. It seems particuarly egregious in this account because victims of electrocution, unless they are incinerated, have a much better chance of being rescusitated than other victims of arrest. State protocols would dictate that CPR should have been continued on this patient until paramedics arrived, and then the paramedics would need to perform at least 20 minutes of ACLS, including intubation and ACLS drugs, and even then because the patient was a victim of a lightning strike, the patient still should have been transported, unless the medics spoke with a physician and all agreed further efforts were futile.

Now I have screwed up in the past and will do so again in the future, but there are levels of screwup that just aren't acceptable.

I am not blaming the individuals on this call, but if you don't blame the individuals, you have to blame the system that trained them and put them out on the road to operate independently.

The fact is all too often, not just here in Connecticut, but all across the country, EMTs are put on the road, not because they are qualified, but because warm bodies are needed to make legal crews -- to fill the duty schedule. "Meat in the Seat." Bodies are needed so the towns and cities can say they are providing ambulance service for their people. No experience? Not a clue what you're doing? No problem. You have a state card, don't you? And hold on a minute, let me feel your wrist. Ahh, there you go, you have a pulse! Let me show you to the ambulance. Step right up, buckle yourself in. Here's the switch for the lights and here's the knob for the siren. Go nuts!

Now I didn't really know diddle when I started, and I had plenty of calls that I can truly say I was completely unprepared for. I had a 130 hour class behind me, no street experience, and a $6 an hour pay check. Many people don't even have that. I was lucky most of the time when I started I had a senior partner, who did know something, but sometimes, my partner was as green as me. You have to get cars on the road. This isn't a volunteer issue, and it isn't a commercial issue, it's a competence issue. And like all things it is a financial issue.

People want EMS on the cheap. Many services provide too little pay, or no pay. Training is minimal. Oversight is minimal. And the result is viable patients get blankets thrown over them when they aren't dead. And worse things happen.

I desperately want to be respected for the work I do, for the years I have put into the job, the time I have spent trying to improve, to master a job that is not masterable. I look in the mirror and see who I am, but sometimes I look in that mirror and see with other people's eyes. I'm a yahoo ambulance driver village idiot, who probably does what I do because I can't get a real job.

Why do some people see us that way?

Read the article above again. And read this one from February 16. Questions Surround N.C. Man Presumed Dead. And read it again when it happens next time, and the time after.

Now keep in mind that these are just the people who have the blanket pulled over them, and are later found alive. What about all the ones who have the blanket thrown over them while they are still alive and /or salvagable? Who aren't discovered while they are still alive, and who no one will ever know about.

What if the cop hadn't seen the guy breathing under the sheet? Maybe he passes away a half hour later. The crew who called him -- they write their run form. Who sees the run form? Who reviews it to see that they failed to comply with procedures? Do they even write a form? If they do, does it just get stuffed in an old file?

The entire EMS system needs accountability. It has little. That's a dirty secret.

And that's my rant for today.

Forgive me if I am a little pissed off.

***

Did an MVA, a fall at the supermarket, and an abd pain -- possible diverticulitis.