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It is important to understand that I think having passion for something is a very very good thing. Passion can be an energizing driving force that motivates and can inspire you to do things you might not have thought possible previously.

However passion, just like The Force in Star Wars, also has a dark side. Passion can blind you with an emotional rage. This rage will cause you to react to a situation, instead of intelligently respond. This out of control passion was on full display yesterday in the EMS Blogosphere.

The emotional eruption came to full steam between Medic 22 and Timothy Clemans. I am not going to be expressing an opinion on the actual topic, but rather how passion can be a problem in Social Media.

Welcome To The Dark Side… We Have Cookies

Timothy laid the bait at the opening of his blog post when he wrote:

The following is my take on a discussion with Medic 22, a very angry EMT and paramedic student who works for a BLS private ambulance company in South King County.

Whether Medic 22 is angry or not really has no relevance. That’s a personal swipe that was totally uncalled for and is a prime example of baiting a passionate person for that emotionally charged rage type of reaction. In Medic 22’s blog post he fails to take the proverbial high road and writes the following as a closing statement:

Timothy, I called you an idiot in my IM conversation, and that stands. I also stand by the statement that you need to gain some experience in the field, even as an EMT, before you start to judge what is right and wrong with EMS today. You need to see sick and injured people before you can make blanket statements about treatment modalities.

Earlier today, I was pretty pissed when I saw that this kid took a private conversation we had and turned it into blogfodder, than I remembered he’s just a goofy kid sitting at a PC in his mom’s basement typing away… and I realized I don’t give two shits about what he thinks.

Now in all fairness to Medic 22, he felt that a private conversation had been unfairly taken public which spurred his emotional reaction. I can understand feeling this as a violation of… something… but it’s the nature of the electronic beast that what we say on the Internet can outlive us. I look at that as a learnable moment for Medic 22, because you can’t have a reasonable expectation of privacy in what you do on the internet.

However his reaction is still very unprofessional and belittling of another person’s opinion. Sure it would be nice if everyone who judged EMS actually had experience in EMS. How many Mayors, City Council Members, Senators, and lawmakers judge EMS and create budgets or legislation for it without stepping onto an ambulance? While their numbers have increased over the years, how many medical directors have actual ambulance experience? How many people, who have influence over their local EMS has Medic 22 now alienated from being aligned with our needs from his emotional rant?

It may be none.

It may be many.

We may never actually know… and that’s the scary part.

Don’t Feed The Troll

I think debate between open minded individuals willing to listen to each other and challenge the idea instead of attacking the person is not only healthy but necessary. We as a community should not estrange someone who we think may not be as “experienced” to comment on a situation, but rather take that opportunity to bring them closer and educate them as to why we feel this way and try to understand their point of view. Chances are that there are others with those same beliefs and if we can understand where the misconceptions are originating from then we can identify the source and render a solution.

Everyone has something to contribute to the conversation. We need passionate people to be able to really effect the kind of culture change we want to see in EMS. We need to respect the passion that other people have even when their opinion differs from our own, and keep our passion professional.

However it is important that we recognize someone who is failing to listen to the discussion and is more interested in creating controversy than contributing substance for what they are.

An internet troll.

My advice when these creatures appear is simple… don’t feed the troll lest you run the risk of becoming a troll yourself.

Be responsible with your use of Social Media. Learn the Responder Do’s and Don’ts of Using Social Media while working that I published in July of 2009. For a better understanding of Social Media Best Practices, sign up for the E-mail Bootcamp at PIOSocialMediaTraining.com

There were two blog posts last week that really made me think about where EMS is as an industry and where we need to be.

The first blog post came from Chris Kaiser titled Two Cases, One Letter – From One Paramedic’s Struggle Change Can Come. To summarize the post, it was about a letter from an anonymous Paramedic who had two cases that left him concerned about the priorities of his organization. The first case had to deal with the transfer of a patient with MRSA to a birthing unit, where he did what the facility had called for and did not speak up about the potential contamination of the birthing unit, he was not reprimanded for this failure to identify and prevent a potentially dangerous situation. The second case had to do with a terminal patient being transported for a direct admission and their condition in the paramedic’s assessment warranted them going to the emergency room instead, against the family’s will but in accordance with treatment protocol, which ended in the paramedic being reprimanded for this decision. I left a comment on the original post regarding my thoughts on both cases. This blog post shows us where we are.

The second blog post was Steve Whitehead’s post titled Passion Counts. To summarize the post, Steve points out that to be successful as an EMT or Paramedic you need to have a passion for medicine. I didn’t leave a comment on the post, but instead my opinion will undoubtedly come out in this post. This blog post also shows us where we are, but puts us on the path where we need to be.

Where Do We Need To Be?

Don’t treat your patients, care for them.

I first heard that phrase over a decade ago from a grizzled EMT that most people considered out of touch with what was going on back then. It really resonated with me for quite a few reasons that first time, mainly because I realized that he wasn’t the one out of touch with reality… rather I had been. It reminds me of where we truly need to be as an industry.

One of the things we need to stop doing is complaining about the other healthcare professions and the public lacking respect for our profession. We are providers of a service and as such we can’t expect accolades for providing the service we are supposed to. Really take a moment and think about it. How many of you have taken the time to write a letter or even provide a compliment about a cashier at McDonald’s when they provide you with the correct order? Probably not very many, if any. How likely are you to complain when the order is wrong or not to your liking? Chances are quite a few of you would, if not all. We as a society are not very complimentary to our service providers, which is exactly my point. We need to stop worrying and complaining about these broad perceived injustices and focus on the opinions of those that truly matter… the patient.

When it comes to focusing on the patient, we need to stop thinking of medicine as one solution fits all. There is an absolute need for you to have a strong clinical base of knowledge and understanding. Its true that over time we have slowly moved towards more evidence based medicine influencing our clinical protocols, that does not exclude the unique conditions of patients in both physiology but also emotionally and personally.

We need to be able to listen and understand their wants as opposed to what our protocols dictate their needs are. The true art of medicine is in blending the two together for the best possible outcome. This is the difference between just treating your patient (protocols) and actually caring for them. Yes, you need to be passionate in this job, but you need to be passionate about actually caring for your patient. If we were able to get past being stuck on treating the patient and instead began caring for them, then the respect from the public and other healthcare professionals would come in time.

So make the conscious decision to start passionately caring for your patients as opposed to just treating them.

I’ve always been a fan of EMS1.com for news and insights from the industry, because like most internet connected people I like my media when I want it… which is NOW.

Or maybe later.

It really depends on my mood.

Check out this video coverage on the Chronicles of EMS premiere:

What I really like about that video is their shotgun blast reporting style. Usually when a media outlet reports on a story they focus on one or two individuals. EMS1.com got input from ALOT of people who attended the event.

They even interviewed the video editor.

I think that’s huge… and definitely in the spirit of conversation that spawned the Chronicles of EMS.

There is a troubling story coming out of Pittsburgh about 10 calls to their 911 center for one patient that went unanswered by multiple EMS crews.

According to the story, Curtis Mitchell was experiencing severe abdominal pain during the snowstorm on February 5. The first ambulance dispatched after the second call to 911 was unable to make it through and stopped half a mile from his home. The responders reportedly advised their dispatch that if Mitchell could make it “across the bridge”, they would be able to treat him there. The second ambulance dispatched after the third call was able to make it four blocks from his home, but still could not make it to his house. Again the responders reportedly advised their dispatch that Mitchell would need to make it to their location. After 24 hours and seven more calls to 911 later, Mitchell passed away at his home.

I’m not going to defend the actions, or more accurately the inaction, of the EMTs on those ambulances. The city of Pittsburgh has recognized this as a failure of their system and has said they are investigating it so they can prevent this from happening again. What they’ll be doing exactly is still to be determined.

What I do want to do is answer a question by Mary Bey, Mitchell’s girlfriend’s aunt, that was asked on the CBS Early Morning Show:

“The thing that disturbs me the most is the response from the paramedic. When he made the comment, ‘If he wants a ride, then he’ll have to walk to us,’ I’ve never — what are they running — a transportation system? I thought it was medical.

CBS News attributes that quote to Sharon Edge, however after watching the interview I believe it was actually Mary Bey who was speaking

EMS personnel are trained to provide rapid stabilizing care for a variety of ailments, but more specifically for acute life threatening conditions. They are equipped with medical devices and interventions that are also commonly available in the emergency room of a hospital. There is indeed alot that EMS providers can do today as opposed to just 10 years ago. However, currently all of these treatments and interventions are very limited in their scope because EMS is not designed for long term, middle term, or even short term definitive care. EMS is designed as the band-aid between scene and hospital.

To answer that question, yes Mary, it is ultimately a transportation system.

And this blog post? This is the illustration to all the EMTs, Paramedics, and Managers that when EMS is unrealistically portrayed in the media… like perhaps when Medics descend from helicopters and syringes of magical medicine fly from their fingertips curing all in their sight or they defibrillate a patient laying in 3 inch sewer water by doing a handstand with the paddles on the patient’s chest who then sits up and asks why his shirt is burned… it crafts an unrealistic public perception of what we are truly capable of doing.

We need to stop allowing others to craft the expectations the public has of us. We need to tell our own stories. We need to inform the public of who we are and what exactly we can do. We also need to make sure that they know what we can’t do.

More importantly… we need to educate the public as to what it is that we want to be able to do. The Chronicles of EMS have already taken those first vital steps to start the conversation. We need to make sure that conversation continues and that there are actions following it. One of those actions needs to be public education. This is a responsibility duty we all share and owe it to our communities to keep them informed and let them know what we need from them in order for us to succeed.

EMS Week is three months away. Why wait? Start planning your public educational initiatives now. Need some inspiration? Check out these EMS Week Tips from Greg Friese to help you get the ball rolling.

Late last night I was made aware of another case in the Pittsburgh area of an EMS crew telling a mother with ill 11 month old twins to walk to them, and then left when she was unable to do so. This came via Elmer Fudd in this post’s comment section

Sources: Fox News, CBS News

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I came across a series of interesting posts from Greg Friese, Steve Whitehead, and Chris Kaiser regarding the common practice of “CPR Theater” or “Going through the motions for the family” when it comes to pediatric arrests. These are blogs that I read often, and I find myself often agreeing with their observations and points of view. This is not one of those times.

Just for a little background, I spent 2 years working in the Bronx. Out of the five boroughs the Bronx has the highest infant mortality rate of the city (6.3 deaths per 1,000 births in 2005) that has seen a decline in both birth rates and infant mortality over recent years. Both my first and last calls in the Bronx were infant arrests (speculated to be SIDS victims) and there were more than two handfulls inbetween, so I have a bit of insight into pediatric cardiac arrests and resuscitation efforts.

On every single one of those resuscitation efforts I did everything I possibly could, including transporting the pulseless child with their grief stricken parents up front, even when I obviously knew that there was no hope of regaining a pulse short of a biblical style divine intervention. I made sure the parents understood that not only was I doing everything that I could, but that the hospital would do everything they could when we got there. Say what you want about the hospitals in the Bronx, but they never failed me in doing exactly that even when they also knew there was no hope unless the new janitor was also able to turn water into wine amongst other things.

So why do it?

At their very core every parent ultimately wants the best for their children. Now as Dan Carlin points out in Suffer the Children, this was not always the case in society and while we may revert back to it at some time, right now as a society we place a high value on the very essence of life itself.

In fact, we place such a high value on life that we employee people trained to preserve that life the best way we think we know how whenever we know that the essence of life is threatened. We call those people EMTs and Paramedics. We have also scientifically found ways to extend the essence of life by performing changes on our own bodies (such as open heart surgery) and through machine augmentation (such as ventilators and bypass machines) so much that we have doubled the life expectancy of a person in 100 years.

Every parent wants the best for their child, including healthcare and efforts taken to preserve their essence of life. They want to know that everything that could have been done for them, was in fact done for them. So do it. Don’t “go through the motions” or perform “CPR Theater”… actually run the code, perform CPR, and transport as you would a viable patient.

Why?

Because as we hear every so often, there are plenty of patients that are viable when we don’t necessarily think so.

EMS personnel are also not trained or equipped to assist grieving parents either at home or on the scene. Not transporting is denying the parents the knowledge that everything was done for their child, you deny them access to a neutral place they may associate their grief, and professional help on “what happens next”. No parent plans for this event unless there is an underlying condition with an inevitable conclusion. Even if they consider the “what if” scenarios, rarely are they in a state of mind to follow through on what they should do next. This sort of training is beyond just knowing what to say (because in the death of a child there truly are no words, but we should allow our actions to speak for us instead), but more importantly about how to guide them as they step into their new reality.

But aren’t there undue risks involved to both EMTs and the public in transporting a pulseless patient that science says we should leave at the scene?

This is an argument where I sit on both sides of the fence.

On one side, I agree that transporting a patient that qualifies for field termination lights and sirens does create an undue risk and hazard to both personnel and the public.

At the same time, society demands that we respond to these threats to the essence of life expediently even though the perception of that threat may be increased upon by the caller and scientifically the patient’s essence of life is not threatened in the least.

This also creates an undue risk and hazard to both personnel and the public.

Therefore I would submit the argument that as long as society views protecting the essence of life, therefore employing EMTs and Paramedics to protect that essence of life, then the undue risk is an acceptable one. Once society no longer values the essence of life, then we can have real healthcare reform by not extending lifetimes past their expiration with radical treatments such as chemotherapy and radiation, we will be fine with patients who choose euthanasia, and we will no longer place personnel or the public at undue risk because there will be no more ambulances.

The fact is that perception plays as big a role in all of this as protocols. A field termination of a pediatric will leave the grieving family going through the shock of the 5 Stages of Grief without support from trained personnel.

One of the thoughts among them may very well be, “Those Paramedics did nothing! Nothing!” We already have cases of that, and adding that perception from a grieving parent will be damning to not just the agency, but the industry as a whole. This is not the perception we need to maintain. We need to show that our industry is not only able but willing to go that extra mile in the quest to preserve the essence of life.

In most instances, patients and their families do not know good patient care from bad patient care. They do know an effort from no effort and nice from not nice. Every now and then though we’ll come across people who know all three… and heaven help you if that child you chose to field terminate because you didn’t think they were viable happens to be the son of a Chief or Director of a large EMS Agency.

In Conclusion

There are a number of systems with field termination guidelines. While I am a proponent of field termination, specifically for the hospice enrolled patient, I am in opposition to any guideline allowing field termination of a patient under the age of 18 barring significant obvious trauma. Make “No Child Left Behind” more than a failed education initiative, make it your Pediatric Arrest Protocol.

It’s true. I have an addiction.

My name is Dave Konig and I am addicted to movie trailers.

The fact is that when I go to the movies I get there 30 minutes before the show. I don’t but the pretzel nuggets with nacho cheese for the actual show… I buy them for the coming attractions.

The internet is a virtual paradise for someone like me, especially with sites like TrailerAddict. Unfortunately, even they don’t have all the best trailers around because they haven’t been showing this one…

Chronicles of EMS – Trailer from Thaddeus Setla on Vimeo.

Paramedics Justin Schorr and Mark Glencorse travel accross the Atlantic to share their understanding and experiences in EMS. This is the trailer for the pilot episode of “Chronicles of EMS”

Dear Steve,

First off allow me to say that I am glad that you pulled through the transplant surgery as you have. Sure, you could still put some meat on those bones, but at least your moving those bones without the use of an iExoskeleton. I’m also glad to see you’re still rockin’ the black turtleneck.

What I’m writing you about is really of utmost importance. It matters to the citizens of the United States who also happen to be your paying customers that Apple continues to be innovative not just with their hardware, but their software as well. Now that cut & paste exists on the iPhone, there is one glaring hole in the product line.

Emergency notifications.

As you may or may not be aware, New York State is testing an Emergency Notification System through online gaming networks such as the Play Station Network and XBox Live.

THIS is brilliant.

THIS is innovation.

THIS is NOT Apple doing it.

Why not?

Steve, why can’t Apple help to innovate for the Emergency Managers of this country? Why, if someone does an opt-in subscription to receive emergency notifications, can’t iPhones and iPods do the same thing? You put a video camera in them for pete’s sake!

I think this is something Apple needs to look at, and not necessarily leave for third party developers. It’s not about the company. It’s about innovation in the best interest of the customer.

Thanks for your consideration in this matter.

Sincerely Getting A Droid Only Because AT&T Sux,

Dave

Social Media.

The term gets thrown around alot. I’ve already explained what Social Media actually is in plain english.

One of the things that I think gets overlooked most often when trying to define Social Media is the importance of making that connection. There ARE agencies out there doing it, and they are doing it well. I think they should be recognized.

But what about your Agency? Are they worthy of the title Social Media Responder 2009?

PIOSocialMediaTraining.com is currently accepting nominations for Social Media Responder 2009 (#SMR2009). Five Finalists will be selected by a Panel of Judges from the list of eligible Nominees, based on the following criteria:

• Social Media Presence
• Use of Social Media to connect to their communities
• Quality of Nomination Tweets
• Quality of Online Postings and Social Media Conversations
• Quality of Design Elements

Is your Agency worthy? If so, nominate them either via Twitter or e-mail.

Rules and details on nominating can be found at Social Media Responder 2009

You’ll be happy to know that I survived yet another overdose of Tryptophan. I hope you all have survived the horrors of the feasting table as well. Here are some posts from the EMS Blogosphere that I found to be dead on, timely, and interesting from any perspective:

• Rogue Medic pops another balloon in the EMS mythos, this time taking the sacred cow of c-spine immobilization to the slaughter house
• John Solomon is advocating “building a culture of preparedness one gift at a time“. I completely agree with this idea, and have already started compiling a list of items that make great gifts. I’ll share it in a future post
• Dave Williams weighs in on the healthcare debate and the truth about high end users of the current system that you will never find in the proposed bill currently at the Senate

And finally…

• If you haven’t had your fill of compilation posts, Steve Whitehead has posted the EMT Spot EMS November Roundup.

Be safe out there…

NBC has officially ordered more episodes of it’s EMS inspired medical drama Trauma. This comes after an increase in the ratings, including a few weeks where Trauma garnered more viewers than it’s lead in, and once upon a time network leader, Heroes.

Now we all know that Trauma has been highly criticized by the EMS community. However, I would like to point out something that continues to tick me off about the mightier than thou attitude taken by some on this issue.

Last night I watched the WWE Survivor Series on Pay-Per-View. Say what you will, but I am a pretty big wrestling fan and have had the opportunity to work a number of their shows in New York City. The wrestlers are dedicated professionals and their medical staff is truly top notch.

Last night I watched as an EMS crew from Washington DC Fire EMS (or at least one of them was wearing a workshirt from DC Fire EMS) came down ringside and immobilized Rey Mysterio Jr. after his match with Dave Batista. Now I know that in all likelihood, they were told beforehand to come down and immobilize him. They were probably told by the trainers that they should do everything they would normally do for someone with a back injury that was in a car wreck. I know this, because I immobilized Shawn Michaels at the 2002 Summer Slam, and that’s exactly what I was told.

So I did just that. I used a backboard, a cervical collar, did a log roll, secured his head with a Headbed II (the standard at the time), and put him onto the stretcher to be wheeled into the backstage area… where Arn Anderson promptly came over, helped us to unstrap Shawn, and helped him off the stretcher and back to the dressing room. It was all part of the script, and I was totally okay with that because I treated him as I would any other patient.

My problem is that last night Rey was strapped to a backboard with a cervical collar on as it should be, but the head blocks that should have been on either side of his head were actually underneath the backboard as they wheeled him out. As far as I know, that’s an incomplete immobilization.

If the Washington DC protocols are different and allow you to transport without using the head blocks, then please feel free to correct me… but I think that as a profession we need to expect our providers to get it right before placing unrealistic demands of realism on a television drama.

Even if it is “fake” wrestling.