Pre-Hospital Blog

EMS can be better

Why do we still Intubate?

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Seriously. If we are so bad at it, why don’t we just stop?

Opportunities for intubation in the field are rare, I’ll argue that they’re too rare to gain or maintain mastery of the skill, even in very busy systems. And please don’t try to tell me that intubating a mannequin is the same as intubating a person. It is risible to think that intubating the same plastic thing 10 times is equivalent to 10 completely different field intubations (different airway anatomy, different airway secretions, different amounts of vomit, different patent positions, different scene lighting, etc).

There are safe, effective, proven alternatives to intubation, including King LT, CombiTube, LMA, and plain old BVM with OPA/NPA. I’m not even convinced anyone needs RSI, no matter how long your transports.

Throwing the rest to the wind and completely playing devils advocate, I’ll offer that the only reason we still try to intubate is because of some macho paramedic thing: “you can’t take away my toys or I won’t be as cool.”

Written by ben

June 10th, 2009 at 10:09 am

Posted in rants

Myth, religion, and fact

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Rogue Medic has a good post on EMS Mythology that will get your brain going.

We ought to go forward each day realizing that EMS as a profession has only been around for 30 years or so. Where do you suppose Doctors or Lawyers were 30 years into “Doctoring” and Lawyering”?

There’s a lot of work to be done, most of it we haven’t even identified yet. Some places are way ahead of the US.

Written by ben

June 1st, 2009 at 9:17 am

Posted in links,research

Most Emergencies aren’t.

with 5 comments

One of the most important lessons I have learned in EMS is this:

Most emergencies are not emergencies, they are only perceived as such by the people involved.

As far as the job is concerned, this has 2 very important implications.

  1. One of the most important things to do first on scene is to quickly learn whether this is an emergency or not and
  2. No matter the situation, your patient and any concerned bystanders (anyone on scene with an emotional attachment to the patent; friends, family, etc) need to understand whether and why this is or is not an emergency and what happens next.

A witnessed arrest is probably pretty clearly an emergency. An unconscious drunk college student with no signs of trauma who wakes to verbal stimuli maybe is not an emergency, but his hysterical roommates who called might feel differently. The job starts the same in either case: we are called to someone’s emergency. But the requirements of each become vastly different when we arrive and see whether it is an emergency or not.

In either situation, we have work to do.

cf.  Patients Define Their Emergencies (The EMT Spot)

Written by ben

May 27th, 2009 at 1:21 pm

Posted in ideas,rants

This looks like absolute crap*

with 2 comments

In the spirit of ER, Emergency!, and medical shows everywhere that glorify the profession, drastically skew public expectation, and generally make me want to cry, I give you NBC’s Trauma:

I don’t know why I’m upset… It’s not like anyone would watch a show where a guy posts for 12 hours, drinks 4 Venti coffees, takes a nap on the pram, watches 3 movies, and goes home.

Added: HT to Rogue Medic (whoops).

*I’ll probably watch it anyways.

Written by ben

May 13th, 2009 at 5:45 pm

Posted in rants

What happens if we say no?

with 5 comments

In a meeting today, someone offered the timeless reminder that we can’t say no. If someone calls an ambulance and says “I need to go to the hospital” we can’t say “Well, we aren’t taking you because you don’t need to go.”

Why not? I realize that there are probably legal concerns, so what are they?

I want to envision a well-monitored program that allows a the Paramedics in a system to tell a patient that we won’t be taking them to the hospital. This differs from the idea of the “Paramedic-initiated refusal” in that no one is convincing the patent to refuse; we are telling the patient that we won’t be taking them to the hospital.

Surely there is a discreet, teachable, easily monitored set of evaluation criteria that can filter those patients who will not die if they don’t go to the hospital by ambulance. This would be best supported by some public transport system like Access-a-Ride that we have here in Colorado.

It might look something like this:

Patient: “I want to go to the hospital.”
Paramedic: “We aren’t taking you, you oren’t sick.”
Patient: “Well, what am I supposed to do.”
Paramedic: “I’ll call my dispatch and have them send a van over to give you a ride.”
…and so on.

Does anyone do this? Where and how?

Written by ben

April 15th, 2009 at 12:11 pm

Posted in ideas,rants

I’m Back!

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Howdy folks.

Sorry for the unannounced hiatus.

Expect this blog to be back with regular posts on EMS topics including leadership, clinical issues, industry news commentary, and anything elsa that I find particularly relevant or interesting.

See you soon.

Written by ben

January 13th, 2009 at 11:17 am

Posted in Uncategorized

The focus of EMS

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From tonight’s recording of EMSGarage:

In the 70′s. we all watched Emergency and the focus of the industry was on the E.

After that it was all about the M- better training, better drugs, better medicine.

Today, the industry is moving towards a focus on the Service we are giving to our customers.

Maybe we should call it “SME?”

Written by ben

November 5th, 2008 at 8:31 pm

Posted in ideas,Podcasts,random

Get involved: Advocates for EMS

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AEMS’ mission is to promote EMS, educate elected and appointed officials and the public on issues of importance to EMS, monitor and influence EMS legislation and regulatory activity, and raise awareness among decision-makers on issues of importance to EMS.”

Among issues they bat for are increased NHTSA funding for EMS, increased funding for the NEMSIS database, along with other EMS related funding from the Dept. of Homeland Security, Department of Health and Human Services, FEMA, and others.

They also offer, with NAEMT, an excellent website called the “AES & NAEMT Legislative Action Center” detailing current issues in EMS, and highlighting how your state representatives have voted on them. Information is available to write your representatives and urge them to vote yes in support of EMS, along with their past voting record in these areas.

To my knowledge, there is no other group in Washington dedicated specifically to advocate for the EMS industry. I suggest becoming a member if you are able.

Thanks to Chris and Episode 6 of the EMSGarage for drawing me to this excellent organization.

Written by ben

October 21st, 2008 at 12:35 pm

Posted in leadership,links

The Bee Gees do CPR

with one comment

I dare you to try this on a scene:

“A small study by University of Illinois College of Medicine researchers in Peoria has found that 10 doctors and five medical students who listened to the “Saturday Night Fever” tune while practicing CPR not only performed perfectly, they remembered the technique five weeks later.”

Sadly, there are no videos (yet) of people doing CPR to Stayin’ Alive. Instead, here’s the original music video for the song:

[via Lifehacker]

Written by ben

October 19th, 2008 at 7:54 pm

Posted in funny,random,research

TED

with 2 comments

I am at the Colorado Advanced Life Suport ConferenceMike Taigman was speaking yesterday, and he mentioned TED!  I was so excited that someone else had heard about it I laughed out loud.  Then I realized I should share this gem here.

TED stands for Technolgy, Entertainment, Design.  It is an annual conference held in Monerey, CA that “brings together the world’s most fascinating thinkers and doers, who are challenged to give the talk of their lives (in 18 minutes).”  The best part is that they make the best talks available online for free.

I’ve watched several of these through the years, and I have never been dissapointed.  The talks range from serious to hilarious.

I relate this here because I believe very strongly that ideas from anywhere can be incorporated into your practice.  The example used yesterday was this TED talk from author Malcom Gladwell about the history of Spaghetti Sauce.  The point of the video was that the food industry discovered about 25 years ago that there is no one perfect Spaghetti Sauce, there are hundreds; everyone has slightly different preferences and tases.  The point for our purposes: no one learns the same, and no group of people are is looking for exactly the same information.  By injecting variety into your teaching practice, you can reach more people more effectively.

Browse through the available videos and watch one that piques your interest.  I don’t think you’ll be dissapointed.

Written by ben

October 17th, 2008 at 6:57 am

Posted in ideas,leadership,links