Saturday, December 27, 2008

The Awareness Test

This one's been around for awhile but is still worth a watch.
So, paramedic- how's your situational awareness these days?

Friday, December 26, 2008

Going Full Cycle

1403- Dispatched for an unresponsive male- found a 45 year old in cardiac arrest jammed between the toilet and the wall in a first floor bathroom. Ironically the patient had been complaining of heartburn for the past two days and the dining room table was covered with Alke- Seltzer, Tums, Maalox and OTC Pepcid. Our guy had just returned from the pharmacy with the stuff. (Just a refusal for D.C. EMS?)
We got pulses back, and the patient was fighting the tube on the way to the ER- my partner Amy told me after; "We should feel pretty damn good about ourselves, we saved someones life. How often does that happen?" "The magic of Christmas Amy, it's the magic of Christmas"
... And we did feel good- until we got back to the station. The management was well into another manufactured crisis- there was some PR material missing from storage. The thing is huge- it would have taken two people with a truck to move it- I don't think it could have been removed without someone seeing it go. But no matter, one of the many chiefs staggered around the base, shaking her fat head and yelling "I can't believe you people did this!" to the field staff.
I grabbed Amy and pulled her outside- "Welcome back to the real world"
"Yeah, we're assholes again"

Thursday, December 25, 2008

The D.C. Acid Test

Here's an EMS story from the Washington Post- it's about a patient with chest pain who was "diagnosed" with acid reflux and prescribed antacids by the D.C. medics. This would have been just another lazy half-assed performance by the fire based EMS system in the nations capitol except for on thing- the patient died.
D.C.'s chief claims "there was no indifference"- which of course suggests that a pattern of indifference exists and is tolerated throughout the organization.

You can read the story for yourself:



Pedro the Paramedic would like to offer the following advice to the good citizens of Washington D.C. and to the populace of most major metropolitan areas- 
Do not call 911 unless your symptoms fit an extremely narrow set of parameters that exactly fit your EMS services pre- hospital protocols- ignoring this advice could at best subject you to a frustrating interaction with the half asleep wanker who stumbles out of the responding ambulance or at worst, well- sudden cardiac death.

... and so professionalism in pre-hospital emergency care, EMS, takes another whack- I know it's all too easy to criticize when you weren't on the call- but I just can't help asking- when did we paramedics start diagnosing illnesses and prescribing medications? Don't we just treat symptoms based on standing orders-protocols? Bottom line- sure, that is what we do. Not as glamorous as the out- right practice of medicine I guess, but still a thing of beauty when it all falls in place... ah, the good ol' days- when EMS was part of the continuum of care...
Sleep well America.

Wednesday, December 24, 2008

One Save And Some Good, Old Fashioned Medicare Fraud

Dispatched for a male, short of breath. On scene we found a 73 year old male with all the classic signs of really, really bad CHF. Long story short- oxygen, nitro (many), C-Pap- put one in the save column. My partner and I felt pretty damn good about the whole thing- we worked well together, the patient "got better". It was great- that's why we stay in this business.
We then spent the next four hours on what our EMS Supervisor is calling a non emergency transport. In fact it was a four hour, two way wheel chair van trip- that Medicare is being billed for at the ALS ambulance rate. You know your EMS service has some moral issues associated with it's non emergency transport policy when your patient tells you she asked for a wheel chair van and she's more comfortable in her wheel chair but claims "they told me they had to send an ambulance for this kind of thing". This patient walked to our stretcher, sat down, positioned and covered herself. We folded up her wheel chair and took it with us- because when we arrived at our destination she got herself off the stretcher, stood up unassisted, walked over and sat down on the wheel chair. My partner and I wheeled her into the building, dropped her off, had some lunch and then repeated the farce on the return trip. I'm sure once the W word(wheelchair)makes it to billing we'll get orders to leave her on the stretcher "to make things look legit"
You know, aside from being immoral and professionally degrading, it's criminal- it's good old fashioned Medicare fraud. No one seems to care all that much- the folks at Medicare have their heads up their collective asses, the doctors sign off on these shady transports and the EMS managers are not only happy to do them, they'll rig the paperwork.
I guess they'll help pay for all those "water condition" calls we respond to in order to artificially boost our call volume...
... and provide a steady flow of cash for the volunteer board to embezzle...

Tuesday, December 23, 2008

EMS Wage Parity


Ahoy there EMSer- quick question for you- if this were a refrigerator, how much would you be getting paid for hauling it around town and carrying it up and down steps? Well?

Monday, December 22, 2008

Good Samaritans and the Law

Well, you could see this one coming from a hundred miles away. When I'm off duty I look the other way and walk on by- and now it turns out I'm not just a cynical ass, I'm a regular legal beagle.
The bottom line in all this? Yup, you reap what you sow baby, you reap what you sow...

Sunday, December 21, 2008

The Paramedic Shortage Is Over!

...at last, qualified help is here. The kind of help that the dinosaur contingent in EMS management can work with, can live with. The kind of new age Paramedics the public deserves...


Saturday, December 20, 2008

EMS Worker Profile


Let's see if we can't put together a real quick profile of a typical EMS worker. For the purposes of this exercise I don't think it really matters if you are an EMT or a Paramedic- ready, let's begin...
You're a caring, compassionate person- at least on some level. You're an independent worker, a problem solver, a conflict resolver. You're able to complete your mission without supervision or outside help utilizing everything from hand tools to no tools to the resources of an entire city.
You have a strong sense of duty, a sense of obligation to your community and mankind in general...

So, what does that make you in the eyes of the folks you "work for"?
Let Pedro the Paramedic tell you- it makes you the most easily exploited workforce in the nation.

Tuesday, December 16, 2008

Just A 'Couple Shootings...

0218- Dispatched for a shooting, way out of our sector but there was no one closer. Victim was found slumped over the wheel of his decked out SUV- there was brass everywhere, this dude was disliked in a big, big way. At some point in the proceedings the SUV had rolled down the street, side swiped a few parked cars and come to rest against the only tree on the whole block. To put it in X-Box gamer lingo, this was a "melon popper"- we made the pronouncement and called clear.
0443- Dispatched with the police for a male with multiple gunshot wounds who was laying on someones front porch screaming for help. This guy was lucky- they must have sent the apprentice gangsta hitmen after him- one in the left arm, two in the left thigh and one in the ass. Patient says he can't imagine why anyone would want to do this to him. Off to the ER we go.
The local authorities for their part have apparently grown weary of this whole gang violence thing- the drugs, the crime, the shootings night after night- they have moved on en mass to an area wide crack down on Craigslist prostitutes.
So rest assured fellow paramedics, as you pull your vest on for another shift- won't be no Craigslist Hoes out there shooting up the streets.
By the way- does anyone remember the good old days- you know, before paramedics had to wear body armor?

Sunday, December 14, 2008

Healthcare Reform Is Here At Last...

... Forget the nasty rumor that one quarter of all Americans have no health care insurance, that millions and millions more are under- insured, that everywhere in this country baked goods, hoagies and spaghetti are being sold to finance life saving procedures- forget all that, reform is here- first class care is available even to the homeless in this locale- read all about it.

Monday, December 8, 2008

Fun With Supervisors- On Overtime...

... Wow, I'm back after my near fatal introduction to the Denny's Grad Slam- I picked up an open shift, and with no one else available (hey, we are down 32 medics - yup, not a misprint) I drew the Stupidvisor as a partner...
During the pre- shift vehicle check I learned we did not have a functioning blood pressure cuff- and unbelievably not one workable spare in the whole base...
Ah, but there was one in the ancient, decrepit, "extra" Medic Unit stored in the very, very back of our rather large facility...
My solution- take the blood pressure cuff out of the old clapped out, Chevy gas engined, wood paneled, for super emergency use only truck and put it into the fully decked out, ultra modern 2008 unit we were assigned to... but my fellow Paramedics, no- this is EMS after all, the magical place where common sense is the most uncommon virtue of all...
The EMS supervisors solution was to take the new truck out of service- because it was down a B/P cuff- and put the Chivy gasser on the road for the first time in eight months. Our saving grace? Of course, the aversion of the typical EMS supervisor to run an actual EMS call.
So while you ran from one end of the service area to the other, call after call- well me and my Stupidvisor partner sat back at the base, cruised the internet, drank all the cofee and napped.
Yes, this is living, this is EMS nirvana.

Sunday, December 7, 2008

Breakfast at Dennys- a True EMS Hazard




Sunday mornings we usually get as many crews together as possible and go get breakfast. Impossible on a large scale during the week due to the call volume, but on the week-end we can round up two, three, four crews and grab a quick morning meal before the drunks and freaks stagger out of bed and dial 911.
We ordinarily eat at a family owned diner that has great food, great service and is centrally located. Today, today some jackass suggested Denny's... and so we went.

I got what is my normal everyday breakfast order- coffee, orange juice, and a veggie omelet. I guess alarms should have gone off when I heard the fat, greasy she-male cook ask our waitress "Why all them cops in here?". The waitress had that crazy confused look of someone who imagines government plots that end with her boyfriends El Camino being seized by the DEA.

Long story short my friends- I am now shitting and puking like a mad shitter (and puker)- I can't ever remember getting this sick from food. Ever, not anywhere in the world.





... images- http://www.flickr.com/photos/roadsidepictures/, The Poison Denny's






Saturday, December 6, 2008

Gunsmoke

We responded to four shootings in our district today- the police feel like there will be more, something is up in gang world that must be set into balance. The shooters are getting a lot better around here- they still leave the scene littered with brass, and cars and homes riddled with holes, but we only had one transport out of the four.
The first of the calls was a little scary- we were dispatched for a "female in distress". When we went to turn onto the street I saw the police, lots of them, going up and down the block with assualt rifles. Turns out the shooter was down the end of the block basting away as we pulled in- two thumbs up to our pals in EMS Dispatch! Oh, the lady in distress? She was behind the yellow tape crying and wailing- with a gang in hoodies and colors across the street. We bailed- call me when things calm down, I've got a family.
Update- the shooter got away- into the ether... in the midst of maybe 20 coppers with rifles and two or three K9s.
... We just learned there have been a couple more shootings in two adjacent towns, so yeah, I guess something is up.
Yo night shift... keep your heads down...

Tuesday, December 2, 2008

Everything is All Right

Bad day? Crappy EMS schedule, low wages, not to mention your "leaders" are the least qualified members of your organization- wow, that's a lot to deal with... but rest assured my fellow Paramedics, everything is all right...







See? A walrus playing the saxophone- all is good, it's all right...




Go to sleep, it's all all right...

Monday, December 1, 2008

How Hard Could It Be?

... another chapter un-folds in the ongoing drama "Hey, who the hell F***** up EMS anyway?" You say your supervisors decisions leave the staff confused and demoralized? What? Is there some question as to qualifications... this is EMS baby, we don't need no stinkin' qualifications...

The rest, with a video even can be found in the Story from 9news