Bledsoe Column

It's pouring rain. I'm supposed to go to Fenway Park tonight. Not looking good.

I just read the latest Bryan Bledsoe column at jems.com. Here's the link:

All Things in Moderation

Here's some excerpts:

"...during an average EMS career, a provider will reach a point when they suffer a significant amount of disillusionment. It’s not uncommon. We all encounter it. The causes are usually varied, but a common feature is the realization that the majority of EMS calls are non-emergencies. That means that all of the skills and technology we were trained to use are rarely required. This is the dirty truth of EMS."

"...some people in EMS will respond to this inevitable disillusionment in a different way. They determine, often subconsciously, that they’ll continue to use their skills and practices even if the patient does not stand to benefit. As this evolves, they’ll find ways to rationalize their behavior. Before they know it, they will have violated medicine’s most sacrosanct dictum — primum non nocere (first, do no harm)."

"Today, it seems the sign of a good paramedic is one who puts the most needles into bones, frequently calls the helicopter, intubates a child when a BVM will work, immobilizes somebody on a backboard even though most have a less than a 1% chance of a spinal injury, and runs “precautionary Code 3” just for jollies. I’ve been in nearly every state in this great union and often heard war stories from people proud of the number of crichs they’ve done, the number of IOs they’ve done, or the numbers if chests they’ve needled. I always want to ask (but never do) if the patient got better."

"An old internal medicine professor at Texas Tech once told me two things that I follow to this day:
1. Being a good clinician is more about knowing when not to do something as opposed to knowing when to do something; and
2. Never be the first to use a new drug or procedure nor the last to give up an old one."

Here's my favorite line:

"We’re not happy simply taking somebody to the hospital."

Something to think about.