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A New Type of STEMI Alert

One commenter on my last post pointed out what it would be like if we triaged STEMI patients using the same criteria we use for trauma patients. Silverback Medic's comment is funny enough that it deserves a post of its own:

Hey, I'm likin' this concept… STEMI Mechanism…

"Dispatch, I have a 55 year old male involved in a BLT with obvious incursion. Patient was unrestrained with notable mayo to the face and upper torso. Patient was also found to have several Camels, 2 lighters, and pack of chewing tobacco in the left rear pocket. Patient needs to be transported to a level 1 cardiac center based on history, mechanism and bad breath."

I ROFL'ed.

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Posted by Ambulance Driver on April 5, 2011 • Filed under: Uncategorized

On the Cult of Mechanism:

33 comments

Rogue Medic weighs in with his opinion on evaluating vehicle intrusion as a predictor of injury, which was the subject of a recent episode of the excellent EMS Research Podcast. In his post, he states:

"We want EMS to pay attention to the assessment of the actual patient, rather than the assessment of the possible cost of repair of the vehicle."

Word to your mutha, RM. In fact, I'm stealing that line. Next time one of my co-workers makes a silly decision based solely on what the vehicle looked like, I'm going to ask him, "Are you an EMT, or an auto insurance adjuster?"

I've opined before on the irrational degree of faith EMS places in mechanism of injury criteria. For some, it's a belief system bordering on culthood. MOI criteria were developed as a conceptual tool to give us an idea of where and what to assess, and a rough means of predicting what injuries may be present.

It is not the assessment itself.

The proper use of MOI is to guide assessment, not to dictate treatment and transport decisions.

Further in, Rogue Medic points out:

Why do we treat STEMIs (ST segment Elevation Myocardial Infarctions) with the opposite approach?

The dichotomy is that with trauma triage, we accept a 1,000% to 2,000% overtriage rate, while with STEMI triage, we consider a 5% overtriage rate to be unacceptably high.

The reason is because we're activating trauma centers based on what the car looked like, and we're doing STEMI alerts based on what the patient looked like.

While their pack/day cigarette habit, the number of cheeseburgers they routinely scarf down, and whether their daddy died of a heart attack may be pertinent history, we're activating the cath lab based on presentation.

We should be using the same approach to triage our trauma patients.

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Posted by Ambulance Driver on April 5, 2011 • Filed under: EMS dogma, EMS Topics, Patient Management

On Work Ethic, Personal Responsibility and Manning the F*ck Up

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The Borg has a progressive disciplinary policy on absenteeism and tardiness. If you no-show a shift, you get suspended for up to three days. The second time it happens in the next 12 calendar months, you get fired.

If you're tardy, you get a written warning on the first occurrence, a one-day suspension on the second, and termination on the third. If you have no more tardies for the next twelve calendar months after your initial warning, the counter returns to zero and those items are purged from your personnel file.

I think that's more than fair.

Despite that, we wind up firing people for excessive tardiness and absenteeism. I mean, if you have an infrequent issue that precludes you from getting to work on time – say, a mechanical failure on your vehicle or a family emergency – all you need do is call Borg Dispatch and have them notify your supervisor that you'll be late. The Supervisor Drone will review the issue on a case-by-case basis, and decide whether discipline is warranted. Mostly you get written up anyway because granting mulligans on disciplinary policies is a rather slippery slope.

We had an EMT on my shift who was habitually late for work. Every single day, he'd either pull up right at shift change or 5-10 minutes late. He'd get highly offended that anyone would bitch about his lack of consideration for his coworkers. Since he wouldn't "rat people out" on the rare occasion they were five minutes or so late in relieving him, he figured he should get the same courtesy every day he worked. After a while, my partner, who habitually relieved this assclown 30 minutes before shift change, realized he was effectively giving said assclown $120 a month of his own wages, and stopped covering for him.

He got written up twice in a week, and facing termination for his next tardy, took to sleeping at the station the night before so he'd be to work on time. And still we had to roust the little shit out of bed at shift change.

Eventually he got banished from the hive, and no doubt is still bitching to everyone who will listen about the way The Borg treats its drones. Sadly, he is not alone in his lack of work ethic and personal responsibility. Invariably, people like him get fired – usually not soon enough to satisfy his coworkers – and they spend the rest of their days telling people how chickenshit The Borg is, and how glad they are to be somewhere else.

The reality is, they don't belong anywhere in EMS.

It's been 2 1/2 years since my last tardy, and that instance was for a flat tire that made me five minutes late for work. I made the mistake of calling Bitchy Partner instead of calling Dispatch, and she (intentionally) didn't pass the message on to my supervisor. I got a written warning, and I didn't offer any excuses or try to protest. I just made a mental note not to trust BP again, and made sure I gave myself plenty of cushion to get to work on time in the future.

So when I overslept this afternoon and got to work an hour late, I signed my warning without a protest, and my supervisor didn't deliver a lecture, and my relief accepted my apology graciously. Then, we all went outside and I showed them my new acquisition from the gun show.

We all know an anomaly when we see one, and we all understand the importance of work ethic, personal responsibility, and manning the fuck up when you do something wrong.

Why is that so hard for some people to grasp?

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Posted by Ambulance Driver on April 2, 2011 • Filed under: Administration & Leadership, Uncategorized

Still Shrinking

9 comments

329 pounds.

That's down 2.4 pounds since last week, and a total of 31.2 pounds lost since February 1.

I've gotten some emails inquiring as to what diet I'm on, and the answer is, it's not a diet at all. It's simply better eating and lifestyle habits. One lady in Connecticut was astonished at my daily calorie limit, convinced that I'm going to shift my body into "starvation mode," where it will store every available calorie. I assured her that was not the case, and that I've had a great deal of success with this approach before.

In case any of you are burning with curiosity about what exactly the plan entails, here it is in a nutshell:

1500 calories a day. Some days I exceed that by a couple hundred calories, but most days I come in at 1250 calories or so.
Six meals a day. The three main meals of breakfast, lunch and dinner are 350 calories, and in-between snacks are 150 calories or so. It's not specifically low carb or low fat or low sodium, but the eating choices I make pretty much make eating fried foods and anything with processed sugar or processed flour a thing of the past. I get lots of protein by way of fish and chicken. I eat red meat when I want it, but I make sure to stay under my calories limit for that meal. This keeps my metabolism running at high rpm.
I cheat. I mean that in all seriousness. My self-image isn't tied up in my looks, but I would like to be able to get off the floor without my knees protesting, and I'd like to take back up some of the athletic pursuits i used to enjoy. Bottom line is, I'm not punishing mysellf for being a fatass. I'm just trying to be healthier overall. So when I'm hungry, I eat something. When I want to treat myself, I treat myself. The difference is, now I have a slice of pizza instead of the whole damned pie.
I listen to my body. One of the hidden advantages of such a low calorie intake is that you become intimately re-acquainted with what hunger feels like. The good news is, after three weeks or so, the serious hunger pangs pretty much disappear, and my body stops screaming, "Feed me, Seymour!'" So now, when I'm hungry, I eat. The good news is, now I can tell the difference between hunger pangs and my psyche telling me, "You're bored. Shovel something into your face." I listen to the former, and I ignore the latter.
Exercise.

That last one is the hardest. I'm not exercising enough, which is the main reason I'm not shedding the pounds at the rate I was last time. When I was working days at PGHNSTRACH, I walked to work every day, a 3.5 mile round trip. Most my shift was spent on my feet as well.

Working nights on a SSM ambulance is another situation entirely. It's largely a sedentary job, interspersed with occasional moments of extreme exertion. I sit in an ambulance all night running calls, and then I come home in the morning and collapse into bed, mentally drained. I'm in no mood at all to exercise during my off-duty hours.

That looks to change soon, now that the weather is warming up. My days will soon be spent mowing grass, on the lake swimming and skiing, or chasing an 8-year-old through the woods. Summers hold the potential for plenty of the kind of physical exertion I enjoy. By the time EMS Expo rolls around in late August, I'm going to be a radically different looking and feeling dude.

I'm looking forward to it.

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Posted by Ambulance Driver on April 1, 2011 • Filed under: The Incredible Shrinking Ambulance Driver, Uncategorized