Friday, April 27, 2012
Ambulance Response Times in 21st Century America- or " I called 20 minutes ago, where the hell is the ambulance?"
Not long ago I read a news report about a patient who had a bad outcome because an ambulance did not reach him soon enough- a tragic but familiar story I think. Here in The City response times of 20 minutes or more are not uncommon- fortunately a good 90% of our EMS calls are horseshit, but what about that other 10%. Hmm- that's a problem.
So people let's make this short and sweet- as long as the general public continues to abuse the 911 system in the manner they currently do, and as long as EMS managers continue to misappropriate their resources, there will be times when the ambulance will not be available when you need it.
Simple math- and the system is so overloaded now that the little juggling game EMS administrators play does not work any more. No sympathy here- you folks made the problem, you fix it.
Thursday, April 12, 2012
One of the first things you learn working as a Paramedic in EMS is that everyone is a liar. They all lie- grandma, grandpap, the street people, the junkies, the EMS managers and the politicians. The best way to beat a liar is to be a liar- hopefully this quick guide will get you started on a life long love of the art of deception.
Ready? Well let's get goin'...
Keep it simple- remember you're lying so the less you have to remember the better. Junkies always get caught because they can't shut up and their lies just get incredibly complex. Politicians do the same thing but for some reason we let them get away with it.
Don't be afraid of the silence- this kind of goes with the first rule. Just because the other person doesn't reply right away doesn't mean you have to start babbling and trying to fill in the blanks. This is another way junkies and politicians get caught- they just don't know when to stop and eventually trip themselves up.
Drop names- First and last names. Make them up if you have to.
Whenever possible quote a higher authority- here's an example that combines the name drop with the higher authority scheme- “ Andy Linquist from the committee assured us it was ok to be here.” Or- suppose someone asks-”Hey, what the hell are you doing?” , you say- “This is what they told me to do.” They in this case being the Higher Authority.
Practice your sincere face- a lot of people get caught lying just because they look like liars.
Be at ease but not too familiar- if a stranger gets too buddy buddy I suspect they're either lying or working some scam or another.
A big lie is as good or better than a little lie- but not too big. Too big and you either sound crazy or like a liar.
Don't say “Truthfully”, “Honestly”, “No I mean it, seriously...” or anything similar. That just brands you as a dirty, filthy liar. And NOBODY likes a liar.
Well, I hope that's enough to get you started. Watch and learn from all the liars you interact with everyday- but most of all- practice, practice, practice.
Saturday, April 7, 2012
Here's the sordid tale- judge me as you would like to be judged.
It was a dark and stormy night- well it was dark anyway- when our patient entered into a disagreement with another drunk outside a local club. The two of them stood on the sidewalk doing the Fighting Chicken- you know, that wavy arm thing that drunks do before they fight- when combatant "A" punched our patient in the belly. Our patient- let's call him Drunken Tough Guy Jimmy- fell down, rolled around a little, puked and then sat on the curb yelling at his girlfriend. That might have been the end of it- except Drunken Tough Guy Jimmy pushed his girl off the sidewalk and she made such a scene that the police were called.
Now, if you find yourself in this situation- you know; explaining that you just lost a bar fight, puked on the City sidewalk and shoved your 'ho into traffic- you should be calm, quiet and repentive. At least till the cops leave. Not Drunken Tough Guy Jimmy- no, he started screaming at the police. Not a smart strategy at 0300 in The City.
So the police are about to through Drunken Tough Guy Jimmy in the wagon for the trip to jail when he plays the I HAVE ABDOMINAL PAIN AND I CAN'T BREATH card. Yes- here I come in my ambulance.
When we pulled up we found Drunken Tough Guy Jimmy sitting on the curb, holding his tummy and rocking back and forth 'cause "I'm in pain man."
I asked my standard " What's goin' on tonight?" ( By the way- I got that from Grand Theft Auto- the medics in Liberty City always said "Hey, what's goin' on?") Drunken Tough Guy Jimmy decided to be a tough guy again and asked me who I thought I was. I told him I was a City paramedic and I'd love to help if he would just let me.
Drunken Tough Guy Jimmy informed me that I was nobody and asserted that he could "buy and sell me." Not just me but all the assholes like me. Now I could have gone off on him right then I suppose- but I'm a customer service kinda paramedic. So I tried to make a joke out of it- "Is that an offer?" I said with a smile.
Drunken Tough Guy Jimmy replied with a dumb look and a "Huh?" so I repeated my little joke "Are you making an offer to buy me sir?" Again, with a smile. But Drunken Tough Guy Jimmy wasn't getting it- maybe he didn't know if I was laughing at him or with him. He gave me that same dumb look and yelled "What's that asshole?" He started doing the sitting down version of the Fighting Chicken.
Still smiling I told him- " That's what I thought sir- you don't really have the money do you? You can't buy and sell me. You don't even have the intellect to have a conversation with me- do you? Let's try this- you sit there with your mouth shut until I ask you a question. When I do, you answer it and then shut the hell up again. Got it Tuffy?"
After a quick assessment I yelled over to the cops " Hey- this guy's good to go to the lock-up. See you on the next one."
...and then the waterworks started...
Sunday, April 1, 2012
First of all let me tell you in no uncertain terms- YOU WILL NOT LEARN HOW TO BE A PARAMEDIC IN PARAMEDIC CLASS. Sorry- paramedic class exists to give you the answers on the Registry exam. Period. You learn on the streets. You learn how to be a paramedic by paying attention to the human condition. Get it straight or get out.
Second- there is no magic checklist that some instructor is going to hand you to clear everything up. No mystical text or flip book or protocol. You have to use your head. Again- sorry, but it's all on you now.
Hey- here's a quick story. I had a medic student preceptee several years ago who just could not catch on. She was always flipping through her ALS pocket guide or screaming for the protocol book. She's one of the few paramedic students I have advised to give it up. She didn't- she went on and passed the medic test and got a job with a suburban EMS service- an ex-EMS service of the year. I ran into her in the ambulance bay of a local ER one day. She was shuffling through a big stack of hand-written note cards. She looked like she was going to cry. I asked what was wrong and she told me this- " Well, the guy we brought in was really bad. He was having a lot of trouble breathing and by the time I found the right note card he was dead." True story. Don't be like that.
That's it for today- hope that helped. See ya out there.