Category Archives: In the Line of Duty

"So God made an EMT"

Editors Note: To celebrate EMS Week last week, my good friend Eric Garton wrote a poem in the style of Paul Harvey and recorded his narration. It has touched many people so I asked him to share the words here along with a link to the YouTube version. Feel free to share them further, but please give the credit to Eric for his hard work and creativity.

 

“So God Made an EMT”
by Eric Garton   (c) 2018, All rights reserved.
 
And on the ninth day, God looked down on the world he worked hard to create and said,
“I have doctors and nurses in hospitals and clinics. Now I need a caregiver in the field.”
So God made an EMT.
 
God said, “It must be someone who gets up early in the morning, checks their truck off, scarfs
down breakfast, run a cardiac arrest, run two hospital transfers, skips lunch, finish paperwork,
run another transfer, command a horrible car wreck, restock, clean truck, run three sick calls
and hopes for at least four hours sleep before the end of their shift.”
So God made an EMT.
 
God said, “It must be someone who can work continuous CPR on an infant knowing they have
died, and while holding back tears console the family and tell responders on scene, ‘Good
teamwork everyone. Maybe next time.’ “
So God made an EMT.
 
God said, “It must be someone who can manage a patient’s airway while upside down in a
wrecked vehicle. Someone who can calm a ten year old girl and her parents, while splinting her
fractured arm. It must be someone who can aggressively recognize and treat medical
emergencies, yet has the compassion to hold an elderly lady’s hand who fell at nursing home
telling her, ‘I am here for you. Everything will be OK.’ “
So God made an EMT.
 
God said, “It must be someone who is selfless. Someone who will respond to an emergency
without a second thought. Someone who can handle the blood, the guts, the vomit, the broken
bones and give one hundred percent to all their patients. It must be someone who believes in
teamwork and respects all services involved. It must be someone who performs acts of
heroism, yet never calls themself a hero. It must be someone who praises victory, yet not
ashamed to admit defeat. It must be someone who can look the Grim Reaper right in the eye
and say, ‘Not this time.’ “
So God made an EMT.
 
God said, “It must be someone who is loyal to their community. Someone who will put their life
on the line with the hope of saving a complete stranger. Someone who cares more about the
lives they save than the money they make in a year. Someone who will educate themselves,
and willing to share their knowledge with others. Someone who will remain professional and
caring, no matter how minor or major the emergency may be. Someone who can bring their
coworkers together as a family and see them as fellow brothers and sisters.”
 
“Someone who will reply with a smile on their face and a tear in their eye when their child says
they want to spend their life ‘doing what you do.’ ”
So God made an EMT.
 

From Eric: I want to thank all for the support and kindness from everyone who has listened and shared my poem. Many of you have requested a written version of it for yourselves or to share. I hope all of you enjoy reading this to others as much as I have enjoyed reading it to you. Thank you for all that you do.

Download a PDF version here: SoGodMadeanEMT

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Filed under EMS Health & Safety, EMS Topics, In the Line of Duty, News, Opinion, Training & Development

Lights and Sirens and Safety

lightsandsirensThe use of  lights and sirens is supposed to clear traffic by warning drivers or pedestrians that a public safety vehicle is approaching in emergency mode. The expectation is that the use of warning devices increases the safety of both the patient and provider by reducing travel time in responding to a scene or while transporting a patient to the hospital. Conceptually, this visual and audible cue is requesting that other nearby motorists yield the right-of-way to the approaching ambulance.

While lights and sirens are a fundamental cannon of every agency’s standard operating guidelines, their efficacy has never been proven to positively impact patient outcomes. To the contrary, there are examples nearly every day of the failures of these warning systems to provide a safe transport. Just last night there was an accident as an ambulance broke an intersection in Orlando and a few days earlier another crash was reported in Chicago. And literally as I was writing this post, an ambulance from a small town in New York was also hit at an intersection. If warning devices worked, why do we see so many accidents?

In our current age of evidence-based clinical practice, it is more than fair to question operational procedures as well. Studies have shown full use of lights and sirens decrease hospital transport time by only 18 to 24 seconds per mile when the ambulance trip is less than five miles – and there is virtually no time savings at all when the transport is over five miles. Additionally, studies show that the operation of ambulances with warning lights and siren is associated with an increased rate of collisions.

According to a 2010 report on EMS Highway Safety by the National Association of State Emergency Medical Services Officials, “no evidence-based model exists for what ‘mode’ of operation (lights and sirens) should be used by ambulances and other EMS vehicles when dispatched and responding to a scene or when transporting patients to a helicopter landing zone or hospital. A New Jersey based EMS provider, MONOC, has produced a video that aims to protect EMS providers through creating a culture of safety and limiting the times that warning devices should be used. We do know accidents happen when lights and sirens are used. We also know they save very little, if any, time in transport. But no one wants to completely eliminate them. They are in about the same position as the long spine board. We shouldn’t use them as much as we do, but they seem to still have a proper limited space of operation.

In attempting to limit their use, we can come up with some crazy ideas. A new protocol affecting 15 West Michigan counties calls for the use of emergency lights and sirens only to “circumvent traffic,” primarily at intersections, by ambulances transporting patients with life-threatening conditions. Once traffic has been circumvented, lights and sirens are to be turned off. This seems potentially dangerous  as drivers have less warning of an approaching ambulance leaving less time to react. In my experience, drivers are already confused on exactly what they should do when they finally realize we are in a hurry behind them. My other personal concern would be the impression left with drivers when the lights and siren are switched off after “circumventing the traffic.” Will the public incorrectly view the situation as an abuse of the “privilege” to run emergency traffic just to clear traffic? In researching some of these questions, I ran across a serious question from the public asking “if the guy dies do you turn off the siren?” We have failed as an industry to teach the community what we do and how we do it.

The article, “Why running lights and sirens is dangerous” discusses not only the issues faced, but proposes steps that should be taken to reduce the risks associated with driving ambulances “hot.” One objective for safer operation is to reduce the miles that ambulances travel under lights and sirens. The Michigan protocol attempts to accomplish this objective by requiring them to be switched on and off throughout the trip, but another alternative is to change the starting point of an ambulance prior to responding to a call. Many services already accomplish this through dynamic deployment to hot spots of forecast demand which has shown to be effective in reducing both the distance traveled in emergency mode and reduces the overall response time as well.

Carefully consider, within your protocols, when to use the warning devices available to you. Never assume that they “grant you” any right-of-way, as they can only request motorists yield it to you. It is always your obligation when operating an ambulance to drive cautiously for your own safety as well as the public. You can change the culture of ambulance operations to prevent accidents and be safe!

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Filed under Administration & Leadership, Command & Leadership, Dispatch & Communications, EMS Dispatch, EMS Health & Safety, EMS Topics, In the Line of Duty, News, Opinion, Technology & Communications, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus

Does 'Narcan' Deserve Any Debate?

While naloxone (marketed under various trademarks including Narcan) is not a new drug, it has enjoyed some incredible news coverage recently as the “safe antidote” for opioid abuse that can bring an overdose victim back “from the dead” simply and safely with “no side effects.” The surge in its popularity is undoubtedly fueled by a growing problem of opioid drug abuse, especially in the New England states coinciding with the recent development of an intranasal administration option of naloxone. However, stories like, “A drug to stop heroin?” from the Georgetown Record that reads at least in part,

“It works like magic. Spray half-a-dose up one nostril, half up the other and you’ve saved a life”

tend to over-simply the issues involved. Sometimes it works that way, but that doesn’t mean it will every time.

During an overdose caused by opiates, (such as heroin, morphine, oxycodone, methadone, hydrocodone, codeine, Fentanyl and other prescription pain medications) the drug is released into the brain where it binds to opioid receptors. When too many of these opioids attach to receptors on the brain stem, it causes depression of the central nervous system, respiratory system, and leads to hypotension.  These conditions result in poor perfusion and can eventually lead to death. The action of naloxone is not completely understood in detail, but basically seems to displace the opioids on these receptors to reverse the depression of critical life functions. It is important to note that naloxone is only effective at displacing opioids and is therefore not effective against respiratory depression due to non-opioid drugs or illnesses affecting the CNS.  Consequently, recognition of the direct cause of respiratory distress is important in determining appropriate treatment.

Still, even when naloxone is effective at reversing CNS depression, there are conditions that the responder must be prepared to encounter as a result of this intervention. Abrupt reversal of opioid depression may result in vomiting, hypo/hypertension, seizures, VTach/VFib, cardiac arrest, pulmonary edema, severe headaches, severe anxiety, and confusion, not to mention the severe agitation brought about when the patient loses the euphoric feeling often sought from the opioid. There is a safety concern for the “rescuer” in addition to a concern whether non-medically trained personnel can adequately perform the physical assessment of the patient required to ensure the condition hasn’t been misdiagnosed. It appears true that naloxone will not directly hurt patients who are not suffering opioid overdose, but the time delay in proper treatment could be detrimental.

There is frustration on the part of families and even communities afflicted by chronic drug abuse because action is not being taken “fast enough” when the “miracle drug” is known and available. Articles such as, “Massachusetts Police can carry Narcan, but not use it“, where it is reported that even though the state has authorized its use there are still local policy restrictions that prevent officers from administering it, seem like petty politics, or possibly even conspiratorial. I do not advocate undue or burdensome restrictions, but rather welcome a healthy dialog to help all would-be rescuers to understand the ramifications of taking certain actions. I want more equipped professionals to have access to the treatment along with tools such as suction devices, BVM, and an AED to handle possible outcomes rather than simply trading death by one route for death by another. My position on Narcan is actually similar to that of administering CPR. While I want everyone to be prepared to do it, everyone should know something about what results from taking that action. Saving a life is an incredible feeling, but it never comes without some personal cost.

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Filed under EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health, In the Line of Duty, News, Opinion, Patient Management

Second Thoughts on 'Scene Safety'

In addition to my regular job, I continue to proudly serve as a medical first responder in my home community. But, now, in the wake of a Christmas ambush of firefighters last year and yesterday’s hostage situation during a fake medical call, I am thinking back on the doors I have rushed through attempting to offer my help to someone in need. When I respond to that late night page, I review in my head the details given to me by the dispatcher and construct my index of suspicion regarding the medical condition I will likely encounter and never suspect I am entering any sort of trap. Just like you, I was taught to say “scene safe” during my drills and exams, but that was in a classroom setting which is far different than I have ever experienced in the field. Now matter how good your imagination, that fluorescent lit room full of desks and chairs never becomes the cramped, dimly lighted bedroom down a narrow hallway. So, how do we relate the real-world idea of safety concerns into practice in the field? Back in school, we have simulators for patients that can respond to treatments providing feedback on my care and mock-ups of ambulances that even make noise to disrupt the use of my stethoscope, but where is the effort to really teach recruits caution before entering a home? Or even how to deal with the dangerously irate family member once we reach our patient? Maybe we need to go down the hall of the community college and ask the theater students to join our tidy little scenarios as grieving relatives.

And it doesn’t always have to be the setup of a deranged psychopath to present a danger, there are times I have simply gone to the wrong address. And in my state, a homeowner is justified in using “deadly force” on anyone who “was in the process of unlawfully and forcefully entering a home.” Hopefully by announcing myself and asking who called 9-1-1, I can argue the “unlawfulâ€? part if logical debates were possible in those late night situations. Fortunately, I have never found myself in a situation where my life was truly in danger. But I suspect other responders have felt that same casual assurance before things went sideways for them. Arming medics is also not the answer. My “concealed carry” training was very good, but it doesn’t begin to help me understand how to react in a hostage taking situation even assuming my hands weren’t already full of equipment when entering the room.

I read of states like Iowa and New Jersey that are having trouble recruiting volunteers and in some cases offering incentives for service. I have always felt that EMS is a calling however. We don’t just need more bodies in uniform, we need the right people to care enough about helping patients. We also need to do a better job of protecting the professionals (including volunteers) who give of themselves already. We must use the CLIR E.V.E.N.T. database to share experiences of how to make EMS safer and better for responders as well as patients. Take the recent events that have happened and let them make you more aware, not more afraid. Work with others to help them understand the real-world of “scene safety” and practice it in every call. Let your “index of suspicion” always include your own safety, because we need you back doing this job again tomorrow!

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Filed under Command & Leadership, EMS Dispatch, EMS Health & Safety, EMS Topics, Firefighter Safety & Health, Funding & Staffing, In the Line of Duty, News, Training, Training & Development