Archive for April, 2014

Improving EMS in the near future. Part 1.

I’ve been going over a few ideas I have for improving EMS as a whole. I’m going to start a small series detailing some of my points. I will post a new part every Thursday for at least the next 5 weeks. Any ideas on my posts or your own ideas on what is needed would be greatly appreciated.

I’ve said it before, and I’m probably going to say it again many times before my career with EMS is done, we are a young field in the grand scheme of things. I believe some mistakes were made at the inception of EMS and now we are having growing pains.

The first thing I’m going to talk about is education.

We do more on a full arrest than nurses with 4 year diplomas and most of it is on our own without immediate supervision. I’m serious, depending on the service, you can do intraosseous establishment, intubations, ventilator use (something that requires a respiratory tech in most ERs), rhythm interpretation and appropriate treatment. Some systems have the ability to do rapid sequence intubation, tracheostomy, needle decompressions, and very potent narcotic use. Yet we are still not considered a profession.

I have been studying some online classes for my RN degree and have learned something. At the very inception of nurses there were groups of people that were thinking of the future. They were planning and they understood what was going to be needed for future growth as a profession.

Where EMS is still in many communities provided by the lowest bidder Nurses were organizing themselves to protect their investments. Where EMS grew out of direct profit and has for a long time been considered a step child to the fire department, nurses were developing guidelines to establish bare minimums in education. Some of their guidelines included:

  1. The minimum education required for a technical nurse was a 2 year degree. Associates. This was developed for registered nurses and could be considered the foot soldiers of nursing. They can do the technical aspects of patient care and even supervise others in patient care.
  2. The minimum education required for a professional nurse is a 4 year degree. Baccalaureate. They can climb the ladder in different facilities and can take more managerial positions.

Now I’m not saying this would instantly benefit all involved in EMS, I’m not even saying that it wouldn’t hurt some systems that have horrible paramedic retention. I am saying that we cannot be a 2 day a week class for 9 months field anymore. We are not fire fighters, we are not police officers. We are EMS and we have the potential to do things medically to people that have far reaching and long standing consequences.

Any thoughts?

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Greatness

“No really great man ever thought himself so.” – William Hazlitt

I recently heard this quote and it struck something in me. The person that was saying it was talking about Greatness and what that means. He goes on to talk about overcoming one’s self and how that is usually the hardest part.

This is so true it actually hides itself in plain sight.

I have seen it in all facets of life. From the neighbors who race to beat each others yard. The teens who need the latest sneakers or cell phone just to fit in. The church member who has to be the one chosen to help or they’re upset. The paramedic who cares more about certifications and glory than the patient care he is rendering. 

In reality they should be focused on self improvement rather than a meaningless race against a non-opponent.

They say the first step is the hardest but in reality sometimes every step on a journey is tough. First, second, middle, and last. But greatness isn’t achieved easily. You don’t get to greatness with a few easy steps or a half assed few tries.

You plug away at it. You feed that need to become better. You stumble, sometimes you fall.

But greatness comes from getting up, learning from our failures and pushing on.

Don’t start next week, don’t start tomorrow. Let’s start today.

Fighting the Reaper

Yesterday me and mine fought a good fight against a stubborn adversary. We arrived at scene and we were guided to a patient in full arrest.

For those of you not in emergency medicine let me tell you that it is not initially exciting or thrilling in the normal sense of the words. There is a rush of adrenaline but we must take care to control its effects or risk having it derail our work.

In the past few evolutions of ACLS more emphasis has been put on CPR and keeping everyone on task. Someone isn’t doing correct CPR, correct them or rotate them out. Don’t concentrate on getting an intubation and neglect compressions. No need for time consuming IV, establish that IO.

We fought the grim reaper and we won.

During the call we have to be on task. During the call we are concentrating on not missing anything, not forgetting anything.

What is our CO2 reading? Can we do something about this new rhythm he converted to?

We fought Death and we beat it. We brought the patient back.

We celebrate after the call by thanking each other for the help. We retell the story to remind ourselves of our victory. We feel good, competent, but in the back of our minds we know we won a battle in a war we can not win forever.

Tomorrow we may battle against it again and it may not surrender. Tomorrow it may cut us.

But for today we made Death back down, and that’s all we can ask for.