Street Level Paramedic's Blog (24)

A Humorous Example of a Paramedic/EMT Communication Fail

So yesterday I was sitting at home, playing with my computer when the pager went off with both fire and EMS tones.  "Fire department is requested on the interstate, south-bound at Exit 100, for the rollover accident, multiple victims, report of ejection."

In our paid-on-call volunteer department, that's going to be an all-call where everyone available is expected to respond.  I called in, and threw on my coat.  I listened to the radio to determine who was responding so I would…

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Added by Street Level Paramedic on December 9, 2016 at 8:01am — No Comments

A Weak Spot in my Armor

Last week, I responded as a paramedic intercept to a motorcycle versus car.  The rider skidded along the pavement a distance of 84 feet (so the investigators say) before coming to a sudden violent stop by t-boning the car that had pulled out in front of him.

I exited my intercept vehicle, grabbed my ALS bag, and walked toward the crumpled motorcycle next to a crumpled patient.  He was surrounded by firefighters and EMTs.  I looked at the rider's face and could see he was…

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Added by Street Level Paramedic on November 23, 2016 at 11:01pm — No Comments

Shortage of Volunteers or Crisis of Integrity?

It's Saturday morning in a suburb of Milwaukee, population about 11,000, and I'm listening to our ambulance respond for the second time this morning to our neighbor jurisdiction for an EMS call.  They--apparently--have not one EMT available to respond to this call, not even as a first responder while they wait for our ambulance to arrive.  This also means that anyone in our own town needing an ambulance will be waiting longer because our ambulance, the ambulance they pay for with their tax…

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Added by Street Level Paramedic on October 29, 2016 at 11:00am — No Comments

The Medical Director Who Keeps Jumping EMS Calls

Several months ago I responded as a paramedic intercept to a rollover accident with entrapment requiring extrication.  The responding EMS agency was AEMT level, and I was dispatched automatically based on the rollover element of the call.

I arrived on scene relatively quickly, and found the fire department and EMS working quickly to extricate the patient.  Standing at the head of the vehicle was an emergency room physician who I knew well, and who was the medical director of…

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Added by Street Level Paramedic on August 1, 2016 at 12:57pm — No Comments

Bizarre Calls: Blindfolded Children on the Freeway

So here's a gem from my past:

While working a routine 24 hour shift, our dispatcher called my partner and me around 1 am on the radio to give out a "10-15" assignment.  We worked private EMS in a city with a tiered response system.  On an EMS call, we might be dispatched directly to handle the call, or we might be assigned to park a block or two away while the fire department responded to a call.  This would make us a convenient distance away if the fire department decided to…

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Added by Street Level Paramedic on October 28, 2015 at 12:51am — No Comments

An Argument Against Community Paramedicine

Let's see how many people I can make angry with this one...

Community paramedicine isn't paramedicine, it's social work.  It might be economically advantageous to a department because it reduces the number of repeat, unnecessary calls the department receives.  It might bring some relief to EMS workers who immediately recognize the address they were just dispatched to and who know that the person calling simply needs some attention.  But it's not paramedicine, and it's not a…

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Added by Street Level Paramedic on September 27, 2015 at 9:41am — No Comments

The Ghosts on the Corners

Do this job long enough, and you start to believe in ghosts.  I see them all the time.

Sitting in the front of the ambulance, returning from a call, I see the tire marks veering off the highway and ending at a tree where that girl lost control and lost her life.

I see the gas station where the car ended up after an elderly male had a stroke while driving.  The accident didn't kill him, but the stroke did.

I watch as a house drifts past my window.…

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Added by Street Level Paramedic on August 16, 2015 at 10:00am — No Comments

Leadership Isn't Hard Work, It's Just Work

My first supervisory experience came in the hardware department at The Home Depot.  Oh, stop rolling your eyes.  This is back in the days when the founders, Bernie Marcus and Arthur Blank, still ran the place.  Their leadership philosophy was evident in everything that happened in that company.  Their philosophy on leadership was simple:  Take care of your people.  If you do that, your people will take care of the customers, and everything else falls into line.

That philosophy…

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Added by Street Level Paramedic on August 14, 2015 at 5:53am — No Comments

Professionalism and EMS

If you're like me, you probably have a number of news feeds related to EMS, emergency response, firefighting--all bookmarked in your browser and "liked" on Facebook.  You've read the articles about the EMTs and paramedics who have done great things, and others who have done horrible things.  You've read about the major incidents, rollovers, hazmat responses, and dash cam videos of crazy emergency driving and other "caught on cam" events.

But have you really read the comments…

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Added by Street Level Paramedic on May 25, 2015 at 12:41am — No Comments

Have You Ever Regretted Calling Aero-medical?

Have you ever regretted calling aero-medical? I have. The death this week of yet another flight crew member leads me to continue to re-evaluate my use of aero medical. I find myself moving toward the end of the spectrum that calling the helicopter based entirely on mechanism of injury doesn't cut it any more (I'm not talking about getting them in the air--just in case--AS YOU RESPOND to a scene, I'm talking about having them CONTINUE in when you've arrived and done your preliminary…

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Added by Street Level Paramedic on April 29, 2015 at 10:00am — No Comments

Note to Farkles

Note to farkles: I owned a scanner long before I became a paramedic. I listened to the police and fire departments do their work, and I enjoyed having a first-person sense of what was happening in the community. I learned a lot about law enforcement and emergency services, and I considered myself a supporter of all emergency services.

I also knew where the line is. I never put flashing lights in my personal vehicle. I didn't wear uniform-like apparel in the hopes that people would…

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Added by Street Level Paramedic on March 26, 2015 at 3:09pm — No Comments

Private EMS Masochists: Thank You Sir, May I Have Another?

Like so many others, my first EMS experience was in private EMS.  I began my career at a large--very large--private ambulance company that provides interfacility transports, private EMS, and 911 response for a large midwestern, city. The city in which I worked is poverty-stricken and segregated. I travelled from my nice suburban home to the city, spend 24 hours responding to calls, then leave for the safety and green lawns of the outskirts.



Private EMS is a unique amalgam of low…

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Added by Street Level Paramedic on January 14, 2015 at 7:35am — No Comments

Comments on Basic vs. Advanced Life Support Outcomes After Out-of-Hospital Cardiac Arrest Article

I originally began this blog post with an explanation of my education and training with regard to research.  It began to sound like a rooster crowing, so I moved it to the end in favor of beginning with the most important part of my message.

And here it is:

If good science isn't used in conducting research, the results are meaningless.

There is a corollary to this rule:

Conclusions aren't more…

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Added by Street Level Paramedic on December 4, 2014 at 10:39pm — No Comments

The Heart Attack That Made Me a Paramedic

Thanksgiving 2014 passed uneventfully (well, there was a house fire last night and the usual rush of medical calls, but basically uneventful).  I can't say the same for Thanksgiving 2007, the day I went into cardiac arrest twice.

Thanksgiving 2007 was a day that began quietly. No work needed to be done. Nothing was on the schedule except the Green Bay Packer's football game and a ridiculously large meal surrounded by my family in Madison, Wisconsin.  I missed both the game and…

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Added by Street Level Paramedic on November 28, 2014 at 1:58pm — No Comments

Dead People Don't Need Rides to the Hospital

The only treatment for patients in cardiac arrest that is universally confirmed to be beneficial is high-quality CPR.  Everything else we do for patients in cardiac arrest has controversy and doubt.  Fluids?  Pressors?  Anti-dysrhythmics?  Epinephrine?  Stacked shocks?  Three holes (bilateral needle decompression and pericardiocentesis for traumatic PNBs)?  Everything else is grey, not black and white.  High-quality CPR is what has the best chance of helping.  As far as we…

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Added by Street Level Paramedic on November 22, 2014 at 9:20am — No Comments

Quality Assurance and the Freedom to Suck

One of the greatest honors I've ever received is a compliment from a man who doesn't know I ever heard it.  I started as a paramedic in a different fire department, earning my chops there, before my current position.  When I applied to and was offered a job in my current department, my new co-workers were still forming their opinions of me.  One of them, and his wife, happened to know my previous lieutenant, and found themselves talking to him and my name came up in…

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Added by Street Level Paramedic on November 14, 2014 at 5:34pm — No Comments

HIPPA Can Be Your Friend: Sometimes I Just Don't Want to Share

I don't hate HIPPA, unlike some of my colleagues.  True, there are some who take it to extremes.  Also true, HIPPA can be a convenient means of firing someone you really don't want around but you don't have specific cause to fire them for other reasons.  Sometimes, though, it's a very useful tool to help you just keep your mouth shut.

Patient story:  Fat Bastard

Fat Bastard (name taken from the Austin Powers movies) was a 400+ pound jerk who required frequent…

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Added by Street Level Paramedic on November 6, 2014 at 9:45am — No Comments

The View From the Street is Different

The view from the ER is a bit different than the view from the street.  I am convinced much of the conflict between paramedics and nurses originates from this fact.  Social psychologists and people who like fancy phrases refer to something called "cognitive dissonance."  Cognitive dissonance is the stress and internal turmoil someone feels when what they see something that conflicts with their internal values and beliefs.  It creates a certain kind of blindness--an inability to see something…

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Added by Street Level Paramedic on November 6, 2014 at 9:06am — No Comments

Ready...set....PANIC!!!!!

Ebola.  Yeah, I bet you rolled your eyes just now.  I'm sick of hearing about it, too.  In our midwestern state, in our upscale suburban county, the odds are....well it doesn't really matter what the odds are, does it?  Our job is to be prepared.

Any time I'm thinking about preparing for the unlikely, I think about the United Airlines Flight 232 crash in Sioux City, Iowa in 1989.  I went to graduate school in Des Moines in 1990 for my Master of Public Administration degree.…

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Added by Street Level Paramedic on November 5, 2014 at 8:17pm — No Comments

Snatch the Pebble From my Hand, Grasshopper: The Medic Meets the Teacher

If you have a little grey in your hair, you might have understood the reference in the title of this blog post.  For the rest of you, David Carradine had a career before Kill Bill, and one of my favorite televisions series was Kung Fu, which ran from 1972-1975.  Carradine plays a Showlin monk, studying under a Kung Fu master, and he's told he'll be ready to leave the monestary and seek his destiny in the world when he can snatch the pebble from his master's outstretched…

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Added by Street Level Paramedic on October 31, 2014 at 8:00pm — No Comments

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