Standards

So, I remember a time growing up when if your mother asked why you did something incredibly stupid and the answer almost all kids gave was “all the other kids were doing it” and then you’d get the standard response of “if they jumped off a cliff, would you do it too?”

Which brings me to my current rant.  All those years of parental wisdom of not just following the herd for the sake of following the herd.  And now, in the infinite wisdom of these high performance EMS liars disciples, and we all need to do all these “standards” simply because they’re standards.  And when you ask them, why are they standards, they reiterate that they’re standards and when really pressed they’ll tell you the rest of the industry is doing it all as well.

So, Mr. couldn’t hack it as a paramedic EMS manager, you’re telling me that because all the other acolytes experts in chicanery high performance EMS say that we need to do A, B, or C then we do?  Where’s the proof?  Where’s the science?  Where’s the evidence?  Where’s the proof that what you’re doing doesn’t violate the principle of primum non nocere?

We pretend to be scientists, and if Rogue Medic has taught us nothing else we should aim to be that, but, if we’re capable of nothing more than circular logic that is at best faulty, then are we even worthy of pretending to be that?  We should all be ashamed of ourselves for putting our patients, our communities, even our families at risk just so we can follow these standards.

Maybe someday, we’ll come to our senses, get out of this 80’s mindset and start thinking about something other than “me”.  I mean, it’s been 20+ years since the me decade.  Maybe it’s time to do like Burned Out Medic, and think about others.  Just once.  Maybe…

Missing the forest for the trees

Coming up on EMS week 2014 and I was having a thought.

So, we see these nice stories in the academic EMS journals 10th grade reading level glossy magazines aimed at the adrenaline junky, hero craving portion of our industry. All about things like aeromedical and how they truly matter and such. And always, hidden away somewhere is some story about something that really matters. About these places that truly get it and have stopped placing patients in the torture, abuse treatment known as spinal immobilization.

There’s some halfhearted attempt at making it sound, rightfully so, like that should become the standard. And you talk to any of these so called high performance EMS despots leaders and you get some politician worthy lip service about how they’ll look into it.

If we want to be worthy of this years’ EMS week theme of “Dedicated. For Life” then maybe we should try and live up to it. Let’s lose the hero tag, lose the adrenaline junky tag. Let’s get past the “leaders” that crave nothing more than to be a media darling and some good old career advancement.

Instead, let’s drop all that. Drop the ridiculous posturing and turf wars. Drop the “we’ve always done it that way” arguments. Let’s stop missing the forest for the trees. Let’s treat our patients. Treat them fairly, correctly, with science and not always what they or someone else wants, but what they need.

Let’s stop missing the forest for the trees.

Why are we doing this more and more?

So, the inimitable CCC over at Captain Chair Confessions got me thinking with his recent post These people got lights and siren responses  

Why is it, roughly 40 years into this grand experiment called EMS, that we seem to be responding more and more frequently to all manner of nonsense in a code 3 response?

This seems to fly in the face of reason, logic, and science.  I am just wondering why it is that we have many studies that seem to at the minimum, imply that increased use of emergency response proves to rarely provide a benefit and yet it goes on.

We are supposed to use science and reason and all manner of things, but we seem to flaunt it just as often.  I find it pretty damning that many times over the years we’ve even seen Jeff Clawson, of MPDS fame/infamy depending on your mindset, decry the overuse of code 3 responses.  If we have all this evidence pointing to less use of code 3 response, why do we feel the need to adhere to such silly things as 8 minute response time “standards”?  Especially when that “standard” isn’t the same from municipality to the next?

Maybe if we’re going to have all this science and evidence we could use it.  Just maybe.

Clawson, Jeff. “Unnecessary Lights and Siren Use: A Public Health Hazard.” International Academies of Emergenct Dispatch. N.p., Oct. 2002. Web. 11 Mar. 2014. <https://www.emergencydispatch.org/articles/uneslightnsiren.pdf&gt;.

MPDS

So, this is simply an opinion, no facts really to back it  up, just anecdotes from myself and many I know across the country.  Why is it that we are constantly running Code 3 to all this nonsense.  There’s this graduated response system built into MPDS and you know that Joe blow is calling because he’s drunk and wants a sandwich.  You make it an Omega, you still send us, and you send us Code 3?

So, when we go through that red light and the kid jumps from behind the parked car and we can’t stop and kill him, how’s that going to look on the 11 o’clock news?  “Ambulance kills child while responding to local drunk”.  Sure, we can say you could drive slower, etc.  But, in so many systems, if you don’t make the times, your service gets penalized, usually monetarily.  And, if you’re the only responsible one, that means you get to be the sacrificial lamb eventually.

Integrity? Principles?  Those are all great, but let’s face it, most people in Fire/EMS don’t have a lot of responsibility with money and such, and as such we usually can’t afford to be without a job.  So the employer wins.

 

Therein lies today’s question.  Are we really here to do what is the best for the patient?  Or are we here to be a PR machine/appease the lawyers and accountants, medicine and science be damned?  I know this is EMS heresy, and frankly I don’t care.

And we say we provide customer service….

I saw this article, http://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the-ambulance-bill.html?_r=0 , recently and it made me wonder.

In the realm of private EMS, it seems like all the rage these days in high performance EMS is about customer service.  Now if you’re in any other business and the salesman doesn’t have all the information, he isn’t going to do very well.  Somehow though, in EMS sending out the salesman(medic), performing what amounts to scare tactics followed by lack of information is not only considered acceptable, it’s the preferred method.

I’ve seen very few places, maybe I’m not looking in the right places, that inform their medics of all the various charges that the patient may encounter.  Now, if I go into other businesses, I can easily be shown the charges up front prior to being provided with the service.  Even in other medical realms if you ask nicely, you’ll get the costs up front.  But routinely in EMS I’ve seen where you can’t seem to get any sort of straight answer other than we can only tell you how much it’ll cost after you take the ride.  Sounds kind of like the oft quoted statement from Congresswoman Nancy Pelosi “…we have to pass the bill so that you can find out what is in it…”

Not really the way I’d want to run a business or provide great customer care.  But I’m probably not running those places for some reason beyond my ability to comprehend.  And all along I thought we were here for the patients….my bad.

Rosenthal, Elisabeth. “Think the E.R. Is Expensive? Look at How Much It Costs to Get There.” The New York Times. N.p., 4 Dec. 2013. Web. 4 Dec. 2013. <http://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the-ambulance-bill.html?_r=0&gt;.

Evidence based what?

So, with all the hype about evidence based medicine, about peer reviewed literature, double blind studies, and above all the safety of the patients, where is the panacea we seek? It certainly can’t be in blanket spinal immobilization, can it? Are prophylactic IV lines for all the answer?

If not, why do we continue with the status quo? Where are the indignant rages of the medics that know more than that enshrined within the Holy protocols? Why do we continue to bow to these clerics of the pontifical online medical command system? Where lie the heretical medical directors caught up in an apoplectic fit? Why do we continue to provide care that is little more than indistinguishable from patient neglect, if not straight out abuse?

IF this is really about the patient care, then maybe we can do away with medical directors and medical control worrying about the “politics” and maybe just worry about what’s right or the patients? But I guess that’s what we have position papers and academia. Why would we ever think of actually following the advice of so called experts like the American College of Surgeons or the NAEMSP? Are there nothing more than heretics? Or better yet are they simply placed there to keep those of us have taken the red pill from getting too crazy? Where are the gunslingers to protect the innocent victims?

Don’t worry, just keep telling Mrs. Smith that the straight backboard is good for her kyphosis as long as you apply the medical command approved indulgence of “padded voids”? That and your papal medical command blessing and all will be forgiven my son. The problem is when someone pulls back the curtain and exposes His Holiness for the fraudulent “Wizard” that he really is. What then oh supplicants? Til later lads and lassies, stay safe.