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Oops, he already got fired from his day job.
By now, most of you EMS types have read about the South Carolina firefighter-paramedic who got fired over an Xtranormal text-to-movie video he posted on his Facebook page.
Opinions on the incident range from “Whatever happened to free speech?” to “Serves the idiot right.”
Without question, the video was in poor taste. It was profane, scatological, reflected poorly on EMS and the fire service, and played into every tired stereotype of paramedics and nursing home nurses. But hey, if poor taste and potty humor were a crime, I wouldn’t even have a blog.
In my opinion, Colleton County Fire Rescue’s administrators bungled the handling of the incident, and overreacted by firing the medic in question. My guess is that they had no formal policy on social media, but you can bet they, and others, will develop one after this brouhaha. Let’s hope the policies developed are more even-handed and well thought out than their handling of this incident.
Here at The Borg, we were reminded of our social media policy after this story hit the news. I can sum it up for you in one sentence: “Don’t act an ass in public while representing yourself as an agent of this organization.”
That’s pretty broad, and open to much interpretation, but that’s all that really needs to be said. When you post, respect patient confidentiality, don’t air your agency’s dirty laundry in public, and don’t make any statements you’d be ashamed to own, because there is no such thing as anonymity on the internet.
Above all, I think this guy’s biggest sin in posting this video is that it just wasn’t funny. Just another tired anti-nursing home rant, really, one of a gazillion such war stories told by paramedics every day.
I’ve seen a number of these videos across the blogosphere, and none of them are particularly funny. I’ve thought about making one myself, but they don’t have any pure EMT characters, only cops and firefighters, and I reject that on general principles.
Then again, the original was a pretty hard act to follow:
You arrive on the scene for the unconscious male lying in the roadway, cruise slowly past the police cars blocking traffic, and without even getting out of your ambulance, you roll down the window and bark, “Leon! Get your ignorant ass outta the road! Someone runs over you, you might damage a perfectly good car!”
And not only does Leon obediently cease being an impediment to traffic flow, he also hobbles meekly to your ambulance and climbs aboard. You should have seen the face of the cops who called us.
Yes, Leon is a patient we transport all the time, and yes, that’s exactly how the call went down.
And no, there is absolutely nothing wrong with him that about 220 grains of Trepanazine wouldn’t fix.
*Of course, The Borg frowns on us referring to such people as frequent fliers. Rather, they’re valued repeat customers, which everyone knows are the foundation to a successful business.
I know professional football is a business, and for that reason even a favorite player may not remain with a team for their entire career.
Joe Horn went to the Falcons.
Rickey Jackson had to go to the 49ers to win his Super Bowl.
Even Archie Manning didn’t end his career with the Saints.
Still, I think in this situation, New Orleans’ loss is Cleveland’s gain.
After last Tuesday’s round of recoil therapy and ballistic mood enhancers, TOTWTYTR and I ventured south Wednesday morning to Baltimore, site of EMS Last Week Today.
[Editor's nip at the hand that feeds me: JEMS, you do a great job at this conference. The exhibit hall is great, the show is well-organized, with nationally known speakers presenting interesting topics, and for the attendee who gets to attend but one show every few years, it has excellent educational value...
... but, for the attendee who comes to EMS Today every year, or the ones who attend multiple EMS conferences per year, it's getting a little, well, stale. For the past several years, I've perused the list of speakers and topics, and with the exception of a small handful of slots, my overwhelming reaction has been, "Meh. Seen that speaker/topic/presentation before. Even the slides look recycled."
It's not the speakers that are the problem, either, although you do need some new blood. I've seen most of them speak multiple times, and they're all good. But they've got better stuff than the topics you're choosing. I've seen their good stuff before, just rarely at EMS Today.
My suggestion: court a little controversy. Book some speakers nobody has ever heard of. Choose some topics that haven't been discussed and debated ad infinitum in various other forums already. Sure, you risk offending some of your attendees, but trying to concoct a dish that pleases everyone's palate ultimately only makes for a dish that is so bland that it pleases no one. It's the EMS educational equivalent of hospital food.]
Aside from my (admittedly) jaded view of the educational content, I was really looking forward to taking advantage of the real value of EMS Today: meeting people and networking. On that score I was not disappointed.
Once again, TOTWTYTR and I enjoyed the hospitality of a genuine EMS legend, Lou Jordan. Lou’s a lovable old coot with an abiding hatred of skateboarders (he blows the Claymores at the first sight of baggy pants and backwards-facing ball caps), but walking the exhibit hall with him takes hours:
[Walk ten feet]
Lou: “Hey guys, let me introduce you to So-And-So! He was the lead instructor in Jesus’ First Responder class! Taught it from the original Nancy Caroline text, written on papyrus leaves!”
So-And-So (modestly): “I just issued his patch. Jesus had the whole healing thing down pat before he even got to class.”
[Thirty minutes later, walk ten more feet]
Lou: “Hey look, it’s Sumguy, the fella that thought up rotating tourniquets!”
Sumguy (modestly): Well, I owe a lot of that to you, Lou. You’re the one that convinced me leeches were so 19th century…”
Lou’s a walking, talking EMS history lesson, no doubt, and there’s nothing better than drinking beer and listening to Lou and guys like Rick Kendrick swap stories (for you EMS whippersnappers who don’t know who Rick Kendrick is, I’m pretty sure you’ve used a device he invented).
However, I was looking forward to meeting a few EMTs from a more recent generation. Despite being the owner of arguably the biggest online EMS bookstore on the web, Lou is a bit of a Luddite. He still does his personal computing on an abacus, fer Chrissakes, and he’s never quite grasped this whole “blogging thing,” as he calls it.
So we ventured forth onto the exhibit hall floor in search of a couple of guys who, in recent weeks, have demonstrated the power and potential of social media in EMS. Way over by the Zoll booth, tucked into a little cubbyhole were Justin Schorr and Mark Glencorse, the two stars of the Chronicles of EMS.
I was disappointed, frankly. If Patrick Swayze weren’t dead, he’d definitely tell the folks at Zoll that nobody puts Baby Justin and Mark in a corner. But the young lady from Zoll was much cuter than Jerry Orbach, so I let it pass.
This time.
They didn’t seem to mind, though. Justin was busy autographing the boobs of some groupie, and Mark was fielding a call from A.J. Heightman, but eventually I was able to tear Justin’s attention from the boobage, and Mark told A.J.’s people to call his people and perhaps they’d do lunch, and I introduced myself and TOTWTYTR to the Johnny and Roy of the Twitter generation. Justin introduced me to Ted Setla, the man behind the filming of Chronicles of EMS.
Hands were shaken, manly hugs ensued, and much unseemly fawning was done. Sure, Mark Glencorse is an uncommonly charming and ruggedly handsome bloke, but from my buddy’s reaction, you’d have thought Glencorse was the fifth Beatle and TOTWTYTR was a pre-pubescent girl.
Honestly, I had to pry him away before he vapor locked on me, and thus I was unable to let Justin finish signing my boobs.
Disappointing, that.
As we talked, I was struck by how much shorter Justin seemed to be in person, but eventually I realized that was only because I was standing on a small, hobbit-like creature that turned out to be Chris Montera. He brushed off my apology, said something about some podcast thing or another he was doing, and scurried away.
Nice guy, that Chris Montera, even if he hasn’t invited me to be on his show (hint, hint).
While we were moseying about the exhibit hall, we met a few other luminaries of the JEMS EMS/Fire blog network, like John Mitchell and Rhett Fleitz, co-hosts of the Firefighter Netcast. And yes, they do remind one of Chris Farley and David Spade. And they dig at each other like an old married couple, too.
Got to reunite with Mike Ward the Fossil Medic, the man I suspect is largely responsible for the wonderful reception paid us bloggers by JEMS and George Washington University, and met Jamie “Podmedic” Davis from MedicCast. Jamie and Chris did a podcast live from the exhibit hall floor, and Dave Konig was a guest.
Got to hug a tall, smokin’ hawt redhead, namely Epi Junky from Pink, Warm and Dry, and chat with Chris Kaiser from Life Under The Lights, who is neither as tall nor nearly as hawt as Epi Junky, but still a redhead. Friday night at the big blogger meetup, I introduced Chris to Rick Kendrick, and watched him go all fanboi for a few minutes.
Which wasn’t as embarassing as watching TOTWTYTR throw his panties at Dave Statter, but close. In what may be the first such instance in recorded history, someone else scooped Dave Statter on an EMS or fire story. A couple of bloggers managed to get up their posts about the blogger meetup before Dave did.
Enjoy the feeling, guys. It won’t happen often.
Got to meet and talk for quite some time with a guy I’ve been a fan of for years, the EKG Yoda himself, Tom Bouthillet of Prehospital 12-Lead EKG. Chatted at length with Rogue Medic, the Don Quixote of the EMS blogosphere. Shared a great meal with shooter, raconteur and one of the truly good guys of the blogosphere, Old NFO.
Reconnected with a number of friends and met some new ones, among them Bryan Bledsoe, reader Stephanie Goddard, James Laidlaw, EMS1 editor Kris Kaull, Ronnie Grubb of First Due Medic and his lovely wife, NJDivemedic, reader Jared, Nate the EMT-B, and probably a couple dozen others I’m forgetting.
Since I had to fly home Saturday morning, TOTWTYTR and I decided to forego the post-blogger meetup pub crawl, but I’m told it was epic. No one got their Edgar Allan Poe on, and a good time was had by all.
In all, it was a great time, and I thoroughly enjoyed meeting in person some of the people whose blogs I read on a daily basis. Hopefully, we’ll do it all again at EMS Expo in October!
- Northeast Bloggershoot AAR, With Pics!: Now that I’m home and the whirlwind of activity is over, I have time to po… http://bit.ly/cqwQoU #
- And The Winner Is…: … the Silver Bullet.
Rather than put up a poll, I let KatyBeth read the suggestions, and she e… http://bit.ly/d317HA # - Heading home after EMS Today. Check the blog for the after action report later today! #
- Tired.: No blog for you tonight. You come back inna morning, maybe we have blog for you then.
Like when I’m not ex… http://bit.ly/ayNytv # - Came all the way to Baltimore craving crab cakes, only to discover they're getting their crabs less than an hour from my house. #
- Just met @Happymedic and @999medic at EMS Today. Rakishly handsome and charming men, both of 'em. I swooned.
# - A Picture Worth A Thousand Words: The FEMA booth at EMS Today:
In fairness to FEMA, I’m sure that wall isn’t gonn… http://bit.ly/aEnaF6 #
- Signing a few copies of my original book at booth 1606 at EMS Today. Stop by! #
- Beer and cigars with TOTWTYTR tonight, and both of us at EMS Today tomorrow. See y'all there! #
- On The Road Again…: … headed to EMS Today with TOTWTYTR, following a great day of recoil therapy courtesy of Jay G… http://bit.ly/9hNlRv #
- On my way to EMS Today with TOTWTYTR, after some much needed recoil therapy yesterday! #
- Oooooh, BURN!: Overheard at the Northeast Bloggershoot.
Jay G: “Seriously, there’s a warning label you’re suppose… http://bit.ly/awuq8D # - A Bleg For a Good Cause…: … and no, it’s not for me. You guys have helped me out quite enough already.
Fellow blog… http://bit.ly/covJOV # - To the fat, sweaty TSA screener at Lafayette airport: no one does a body cavity search like you, Hilda. Thanks for being gentle. #
- Observations From The Bolance: Discovered tonight on a seizure call:
The map tracking on our computer system does… http://bit.ly/deXUPZ #
- Ambulance Driver’s Aimless Tweets: There's a personal injury lawyer here that bills himself as the "tough, smart l… http://bit.ly/anNa15 #
Now that I’m home and the whirlwind of activity is over, I have time to post on the past week’s activity.
Monday, I had The Ex drive me to the airport, whereupon I left The Silver Bullet in her care for the next week, since the tranny on her Family Truckster shit the bed. Once at the airport, I submitted to the usual tender ministrations of the Too Stupid for Arby’s Transportation Security Administration drones, and aside from the body cavity search by a very large and sweaty woman with a moustache and a lazy eye, made it to Boston relatively painlessly.
That evening, we had dinner at Jake’s Dixie Roadhouse. Jay G, Weer’d Beard, Borepatch, TOTWTYTR, Aaron the rocket scientist, Libertyman, Zeeke42 and Medic Matthew were in attendance. Much tasty barbecue and alcohol was consumed (but not too much), conversation was lively, and various gunny and political topics were debated.
And with apologies to Jay’s AAR, the real Quote of the Night was this one from Weer’d Beard:
“Actually, if you’ve ever watched Home Improvement, it’s pretty obvious that Wilson swung both ways.”
Gotta keep on your toes at these things, folks. You never know where the conversation is gonna go.
**********
Tuesday morning dawned bright and fair, and TOTWTYTR and I drove to Harvard Sportsmen’s Club to meet the others for a day of recoil therapy. Unlike the name implies, we saw no one at the club wearing polo attire, and there wasn’t a croquet mallet to be found anywhere.
There were, however, enough firearms and gun nuts in attendance to take over a small third-world country.
Or Boston, whichever.
A few of the pistols brought by our host, Ross.
And just a few of the rifles...
Don't know who brought 'em, but we all shot 'em.
Borepatch airing out TOTWTYTR's sweeeet Enfield.
Comrade G. getting his Vasily Zeitsev on.
That's a fair amount of money converted into smoke and noise!
One thing our hosts pointed out illustrated the idiocy of gun laws in Massachusetts, and made me thankful, once again, that I live in a free state. The following pic violates the law in Massachusetts that states that only licensed gun owners may transport ammunition, or any components thereof:
How'd you like to have your gun rights denied because you got some brass stuck in your boot?
That’s a felony in Massachusetts.
Kinda makes you question the law that denies convicted felons the right to own a firearm, doesn’t it, when committing a felony can be so absurdly easy?
At one point, our range host wandered down the firing line to the steel popper plates and politely, but firmly, reminded Jay that full-auto weapons were not allowed at this section of the range. Imagine his surprise to discover that Jay’s bullet hose was nothing more than his Remington Nylon 66.
One of our cohorts remarked that if Sarah Brady knew a Nylon 66 could be fired that fast (although not accurately – This is Jay G. we’re talking about, after all), she’d immediately push to outlaw it. Naturally, this led to a video opportunity to metaphorically massacre a whole litter of Sarah Brady’s kittens:
And of course, no Northeast Bloggershoot would be complete without a Jay G. bayonet charge. This time, he’s skewering a Barney target with a 12 gauge Mossbery shotty. Forgive the vertigo-inducing sideways video, but for the life of me, I can’t figure out how to rotate it:
In all, it was a wonderful time with some great guys, and a much needed respite from work and deadlines. Thanks again to Jay and Ross for putting on this shindig, and to my borther from another mother TOTWTYTR for putting me up for a couple of days.
Coming soon, the EMS Today AAR. Stay tuned!
Rather than put up a poll, I let KatyBeth read the suggestions, and she emphatically chose Shortcircuit’s entry over all others. Since this is probably the truck I’ll drive for the next ten years or so, there’s a good chance it will be her first vehicle as well, so I figured she ought to have a say in naming it.
Shortcircuit, drop me a line with your addy, and I’ll sign and ship the book out to you soon.
No blog for you tonight. You come back inna morning, maybe we have blog for you then.
Like when I’m not exhausted and half-drunk.
The FEMA booth at EMS Today:
In fairness to FEMA, I’m sure that wall isn’t gonna stay blank forever. Undoubtedly, they’ll post some of the lessons learned…
… the day after the conference ends.
… headed to EMS Today with TOTWTYTR, following a great day of recoil therapy courtesy of Jay G. and fellow members of the Northeast Shooters.
Batteries recharged, creative juices flowing, and stories to write, so look for gun porn and range reports later tonight, and a few EMS tales to follow soon thereafter!
If you’re going to EMS Today, look for me there somewhere around the exhibit hall at the EMS1 booth, or at The Nest around 5:00 pm Friday, or at the JEMS EMS/Fire Blog meetup Friday night!
Overheard at the Northeast Bloggershoot.
Jay G: “Seriously, there’s a warning label you’re supposed to attach to the gun when you fit it with the Lasermax guide rod laser sight. Now, I ask you, the only way you’ll ever risk getting your eyes damaged with it is if I have my .45 aimed at your head. Laser damage to your eyes is the least of your health risks at that point!”
Ambulance Driver: “Not really. I’ve seen you shoot.”
It’s like clubbing baby seals, folks. I feel a little guilty when he sets himself up like that.
… and no, it’s not for me. You guys have helped me out quite enough already.
Fellow blogger Leslie, from Leslie’s Omnibus, has posted the story of a Chicago police officer paralyzed in the line of duty. When he awoke after the accident that robbed him of the ability to walk and care for himself, his fiance married him, right there in his hospital room.
Takes a pretty special bond to commit yourself to a person, I’m thinking, especially knowing that the future holds a lifetime of pain, hardship and expensive medical care.
Now, 9 months later, he’s strong enough to stand beside her in front of God, family and friends, and pledge his love to her in the formal wedding she always wanted.
Read the story, and decide for yourself if they aren’t worth a little help.
As promised, pictures of the new ride:
2010 Toyota Tacoma 4×4, and with the interest rate I got, I’m only paying about $25 more in monthly notes for 60 months through Toyota Motor Finance than I would be paying for 72 months through my credit union. Even better, only about $100 a month more than I’d have payed for the 2006 Tacoma 4×4 with 91k miles on it.
I can afford the payments, but the truck would have been impossible to purchase without the donations of a number of you good people going towards a down payment. I can’t thank you enough for that.
Of course, toting a new monthly note means less gun acquisitions -*sob!* – but my new ride is downright purty, and she matches the color scheme of my bike. In short, she’s hawt, and she makes me happy in my pants.
In fact, she’s so hawt that I just don’t feel right calling her Frankenhoopty II. She deserves better.
So, I’m offering a challenge to you, my readers. What shall I name the new ride? Leave your suggestions in the comments, along with why that particular name suits me and the new ‘yota.
In a few days, I’ll pick the top five suggestions, and put them up in a blog poll for voting. The person who submits the winning suggestion gets a signed copy of En Route.
So get crackin’!
Discovered tonight on a seizure call:
- The map tracking on our computer system does not accurately pinpoint the location of the parish juvenile detention center. However, if you follow the turn-by-turn directions from the GPS navigation program in our mobile data terminals, it will lead you directly to Chuck E. Cheese.
- 16-year-old seizure fakers, as a general rule, aren’t very talented actors. Let’s put it this way: the kid we just transported was no Haley Joel Osment. I doubt he’d have even made it as Screech’s understudy in Saved By The Bell.
- There's a personal injury lawyer here that bills himself as the "tough, smart lawyer." Like you'd otherwise hire a dumb, wussy lawyer? #
- Since I Never Watch Network Television…: … I never watched One Tree Hill or Scrubs, and thus have never heard of C… http://bit.ly/cPjscS #
- Bigfoot, Aliens, and Occult Spinal Injury: Question: What do the above things all have in common?
Answer: All of t… http://bit.ly/9UZ5w3 # - How Desperate Is Toyota Motors?: Desperate enough to extend credit to someone like me, apparently.
After being tur… http://bit.ly/atKOs6 # - I'll save you some groundhog courtbouillion. Get the rice ready. #
- The Credit Union Gods Have Smiled Upon Me…: … and I shall be car shopping today with considerably broader options … http://bit.ly/ddw7kN #
- If the wait time is the biggest factor in choosing an ER, you don't need an ambulance. This ain't a restaurant, and I ain't the maitre d'. #
- Ambulance Driver’s Aimless Tweets: *Sigh*: Lately, seems like everybody I know is dead.
A month or so back, I got … http://bit.ly/avMZgh #
… I never watched One Tree Hill or Scrubs, and thus have never heard of Citizen Cope.
Thanks to my friend Valerie, now I have.
Give him a listen, you might like him.
Question: What do the above things all have in common?
Answer: All of them are things in which some people desperately wish to believe, despite the utter lack of credible evidence of their existence.
Now, before you roll your eyes and say, “There goes AD again, making unsupported blanket statements just to make his point,” I will cop to just a little hyperbole:
Bigfoot may actually exist.
I’ve seen plaster casts of his feet, after all, and that Patterson film looked pretty convincing to me.
But one thing that I’ve never seen, never treated, never even heard of in fifteen years of EMS, is a spinal injury not accompanied by readily detectable signs and symptoms.
That’s what occult means, after all. Hidden, as in “never had a clue until we looked at the x-rays.”
Yeah, I know every EMT has a colleague who dates an ER nurse in another city who works with the nurse who treated the guy that walked into the ER under his own power with an unstable hangman’s fracture who, had he even turned his head this much (fingers held about an inch apart for dramatic emphasis), would have been paralyzed for life!
Just like the guy who was painting his house in the nude, and somehow fell off the ladder and wound up lodging a paintbrush handle in his rectum, just about every EMT has heard some variation of the occult spinal injury story.
Hell, I’ve even told that story to my students, back when I actually believed there was some benefit to spinal immobilization.
Now, I’m not so sure.
Few EMTs understand the rationale behind spinal immobilization, or since immobilization is rarely possible, more accurately referred to as spinal motion restriction. When you’re trying to convince the belligerent drunk behemoth that he’s strapped to a rigid board for his own good, and he continues to demand that you “Get this Goddamn thing offa mah neck!” while writhing beneath your three straps and your flimsy cardboard or styrofoam head blocks, true immobilization is an academic exercise at best.
What we do instead is document our steps to restrict spinal motion, including everything we did to convince the belligerent drunk behemoth that strapping him to a board isn’t our idea of fun either, but still necessary.
First, spinal cord injury can basically be divided into two broad categories: primary and secondary.
Primary cord injury occurs at the time of the accident. It’s done. Nervous tissue is contused, destroyed, what have you, and it happens when the accident occurs. Immobilization is a moot point for such injuries. Keeping them still is not going to reverse or even limit that damage.
What spinal motion restriction proposes to limit is something we call secondary cord injury, which occurs after the fact. It may result from post-injury cord inflammation and ischemia, or bony fragments impinging on previously undamaged sections of cord, or worsening an existing primary cord lesion. Restricting movement in patients with spinal cord injury limits the potential for further damage.
At least, that’s the theory.
And that’s all it is really, a theory. Peruse all the medical literature out there, and you will find little, if any, evidence that restricting spinal motion actually accomplishes what it proposes. In fact, the best information you will find merely confirms that, at best, it does no harm.
Moreover, we have just about zero evidence that restricting movement for patients with spinal fractures and no cord injury – the patients who are neurologically intact – does any good at all. The vast majority of those patients have stable fractures, and thus gain no benefit from being strapped to a rigid board.
What you will find, however, is an increasing body of evidence that the practice is not a benign, precautionary procedure at all. It does indeed cause harm, and all for the theoretical benefit of reducing secondary cord injury.
Pain and anxiety.
Vomiting and aspiration.
15% reduction in respiratory capacity, and that’s in healthy, non-obese people.
Increases in intracranial pressure.
Pressure necrosis to occiput, sacrum and heels.
All of these things are possibilities when we strap someone to a spine board, and all for a clinical benefit more theoretical than proven.
Here at The Borg, we have a spinal clearance algorithm of sorts. Like all spinal clearance algorithms, it relies on the presence of a very reliable indicator of serious injury: pain. Sure, there are other indicators of neurological compromise that we assess, but the big one is pain.
If someone breaks their neck, pain will result. Not just the diffuse “Man, my neck kinda hurts,” pain that you commonly see in cases of acute insurance-itis, but specific, midline posterior cervical spine tenderness above the area in question.
Of course, there are other elements that point toward spinal cord injury that need be assessed as well – focal neurological deficits, for example. Just the other night I boarded a male motorcyclist who straightened out a curve, based on nothing more than his complaint of numbness and tingling in his hands. It could have been nothing more than cold weather and crappy riding gloves, but it could also have been the telltale signs of a cord lesion.
He swore his neck didn’t hurt, and I found no signs of injury at all – thank God for muddy, grassy fields! – but I boarded him anyway. Of course, after a two-hour wait on the board in a busy ED, it was determined that he didn’t have any spinal injury, and he was taken off the board.
The presence of pain is what makes an occult spinal injury not occult at all, and in all my years in EMS, I have never encountered a single reliable patient with an unstable spinal fracture that didn’t have it.
Not one.
Now, not every patient is reliable, hence the other elements of the spinal clearance algorithms that assess mental status and potential distracting injuries. If the patient is deemed to be unreliable due to organic or chemical impairment, or the fact that he seems to be focusing all his attention on his broken leg rather than your fingers walking down the back of his neck, we restrict spinal motion anyway, just as a precaution. It’s the prudent thing to do.
Well, that is, if you believe that boarding and collaring someone is actually beneficial for a patient with spinal cord injury. There is at least one well-constructed study out there that shows otherwise, in which spinal injury patients who were immobilized had significantly worse neurological outcomes than those who were not. I wrote about it a couple of years ago. Go read that post, and then come back.
Either there's an entire ward full of people in halo devices, or most of these boards were unnecessarily applied.
Recently, Baylor College of Medicine released another study that says much the same thing.
For patients with penetrating trauma like knife or gunshot wounds, there is no reason to immobilize if the patient is neurologically intact. Nonetheless, it’s common practice in many EMS systems to collar and board shooting victims, even if the time spent immobilizing in the field doubles the patient’s chances of dying.
By God, we’re gonna save you from being paralyzed, even if it kills you!
The National Emergency X-radiography Utilization Study was designed to develop a specific set of clinical assessment criteria that would help cut down on the number of unnecessary cervical spine x-rays in Emergency Departments around the country. It has been validated in many thousands of patients, and generally speaking, those clinical assessment criteria are more accurate than x-rays in ruling out cervical spine fractures.
Of course, NEXUS is rarely used as it was designed. It’s been my observation that the Emergency Department physicians use it to clear patients off our board, but the patient still gets the x-rays anyway. Now you may ask, why do they remove patients from our boards, when we obviously boarded them for a reason, using the same set of criteria?
The reason is that many EMS spinal clearance algorithms, including the one used by The Borg, do not use NEXUS, but instead are modeled after the Canadian C-Spine Rules, which note a higher incidence of spinal injury in patients over age 65, and patients who have sustained significant injury above the clavicles.
Of course, these two additional criteria don’t mean that the patient has a spinal injury, they just suggest that we look at these patients a little more carefully. EMS often adds an additional criterion, the nebulous and subjective “significant mechanism of injury.”
Rather than use MOI as it was intended – as a conceptual tool to tell us where to focus our assessments – EMS tends to use it as the assessment. We place all of our faith in the mechanism, and precious little in our actual assessment findings. We’ve built an entire belief system around it.
This misplaced faith in mechanism of injury is what transforms a useful clinical tool like a spinal clearance algorithm into just another poorly written protocol, where we shoehorn patients into a set of unnecessary treatment steps that offer no benefit.
The state of Maine, pioneers in the use of a statewide field spinal clearance algorithm, has been using NEXUS criteria for ten years now. Everyone from the newest EMT to the most seasoned medic can apply it. Several years ago, they dropped mechanism of injury from the list of assessment criteria because MOI was too unreliable an indicator of injury.
So far, no one has seen an inordinate percentage of quadriplegics tooling around Bangor or Portland in their motorized wheelchairs, and we’ve heard no reports of juries awarding record monetary damages for the patients who weren’t collared and boarded. It may just be that they’re on to something up there that other EMS systems around the country would do well to copy.
The Borg have a spinal clearance protocol, but its benefits are diluted because they insist on immobilizing anyone with a significant MOI, or patients over age 65, or patients with an injury above the clavicles. Not “exercise due caution” in these patients, mind you, just “immobilize.”
No ifs, ands or buts, no exercising clinical judgment, no consideration of what’s best for your patient, just immobilize. Strap ‘em all to a board, and let the radiologists sort ‘em out.
Now imagine yourself, say, at a bar. You’re flirting with the waitress, nursing a Coke because you’re drew the short straw for designated driver, when all of a sudden and for no reason, Sumdood clocks you right in the mouth. Splits your lower lip and knocks out a tooth, the bastard.
But you’re pretty badassed yourself, and you didn’t even leave your feet. You’re more pissed than anything, really, and would like nothing more than to exact a little revenge, but Sumdood, as he always does, has vanished like a wisp of smoke. Your buddies cluck sympathetically at your mangled lip and missing tooth.
“Dude,” they say, “you oughta get that checked out. Call an ambulance or something. You’re gonna need stitches and everything.”
So then the ambulance arrives, crewed by Rookie Partner and a burly but nonetheless rakishly handsome and devilishly charming paramedic, namely… me, Ambulance Driver.
“Yep, that’ll need stitches,” I agree as I examine your face. Other than the split lip and missing tooth (carefully stashed by your buddy in his go cup filled with a White Russian because it has milk in it, and everyone knows you’re supposed to put dislodged teeth in milk), there isn’t a mark on you. Your pupils are fine, you didn’t lose consciousness, your neck doesn’t hurt when I palpate it, and you’re moving all your limbs appropriately. I even have you close your mouth and smile, checking for malocclusion of your teeth that may tell me you’ve suffered a fractured jaw.
You’re moderately impressed by my thoroughness, and thankful that The Borg employs such dedicated and skilled medics. They’re a pretty damned impressive outfit, you’re thinking. They’ve got their shit together. I’m in good hands, you’re thinking.
And then I say it.
“Um,” I say apologetically, “to take you to the hospital, we’re gonna have to put a collar around your neck and strap you to a board.”
“But I didn’t hurt my neck!” you protest. “Why is that necessary?”
“We have to,” I repeat, mentally biting my tongue to keep from agreeing with you wholeheartedly. “It’s, um… well, it’s the protocol. It’s for the best, really.”
“So you’re saying that strapping a guy with nothing but a split lip to a board is actually in his best interests?” you ask dubiously. “Dude, what have you been smoking?”
But hey, the guy has an injury above the clavicles, and the protocol clearly states that I’m required to immobilize that guy.
That’s a scene I am forced to repeat, day in and day out, several times a shift. And I am faced with the choice of explaining to my patient that my medical director is not a monosynaptic, booger-eating dullard, just that he writes protocols designed to be used by medics that are, or I can follow the protocol as written and have the patient think I’m the monosynaptic, booger-eating dullard.
Either way, it doesn’t reflect well on The Borg, or EMS in general.
Ironically, the same medics who immobilize everyone in the belief that if it keeps even one patient from being paralyzed… are the same medics who are card-carrying members of the No Neck Fits Everyone Society, and believe that three straps are all that’s necessary to properly secure a patient to the board.
Now, being an ornery type who refuses complete assimilation into the Hive Mind, I rebel at doing unnecessary and potentially harmful things to my patients, and carefully explain to them that they have the right to refuse any medical treatment that we offer *wink wink, nudge nudge*. Sometimes I just refuse to follow the protocol, and I get my pee pee whacked for it fairly regularly.
But a great many of my colleagues don’t even go that far, and simply follow the protocol blindly, never questioning the wisdom (or lack thereof) behind it. Some of them even tell the patient things like, “If you want to go to the hospital on my rig, you have to go on the board.”
That’s a practice that doesn’t just flirt with the legal definition of coercion, it gives it a naked lap dance and slips its cell number and hotel key into Coercion’s pocket. It’s wrong, and we shouldn’t make our patients submit to painful and unnecessary treatments just to get the help they seek.
Every time the FTO Drone whacks me on the pee pee for not immobilizing someone needlessly, he’s almost apologetic about it. “It’s not you, AD,” he’ll say as I’m taking the online spinal immobilization tutorial for the umpteenth time, “it’s all these other yahoos who aren’t using their heads at all. If we’re going to discipline them for it, we can’t let you get away with doing the same thing.”
And he’s right. Discipline needs to be applied uniformly, even if it occasionally requires that a good medic who exercises his brain receive the same punishment as the bad medics who didn’t.
Of course, they could also re-write the protocol to allow more freedom to exercise clinical judgment, and hire medics worthy of that level of trust.
Like, you know, ones that don’t believe in Bigfoot, aliens and occult spinal injury.
Desperate enough to extend credit to someone like me, apparently.
After being turned down by everyone from Ford Motor Credit to Benny the loan shark, my credit union came through with financing terms. I was waffling between a 2006 Toyota Tacoma SR5 4×4 with 91k miles (but in excellent condition with tons of extras), and a brand new 2010 Tacoma 4×4, which I could have had for 2% lower interest than I’d get with the used one, and 72 month financing, to boot.
In the end, having a new vehicle with a 100k mile factory warranty for only $100 more in monthly notes was just too good to pass up.
So I went to the dealership this morning to sign the buyer’s agreement, and they asked if I’d like to try getting approved through Toyota Motor Credit. “What the hell,” I figured. “One more hit to my credit record won’t be too bad, and this is the last time I’m going to be financing anything for a long time. They’ll probably turn me down, but I still have the credit union to fall back on.”
Well, not only did they approve me, but at an interest rate so much better than my credit union that I could finance the truck for 60 months for only $70 a month more in payments. That will save me roughly $7,000 over the term of the loan.
So thanks, Toyota Motor Credit!
Hopefully, I’ll have pics of Frankenhoopty II by the end of the week!
… and I shall be car shopping today with considerably broader options than I had just three days ago.
More to come soon, and actually some EMS posts!
That is, as soon as I procure a ride…
- *Sigh*: Lately, seems like everybody I know is dead.
A month or so back, I got a Facebook friend request from the … http://bit.ly/c6KL3M # - Thinking of starting my own one-man play, ala "The Vagina Monologues." Working title: The Penis Soliloquy. #
- As Usual, The Truth Is Somewhere Between The Extremes: Most of the EMS internet forums have been abuzz lately with… http://bit.ly/9ejU3Q #
- I need to patent a hand-held nebulizer with a cigarette port, perfect for the COPDer too short of breath to smoke. I'd make a fortune! #
- It’s a Bird, It’s a Plane, It’s a…: … mid 90’s Mercury sedan equipped with nine video screens!
Yes, you read tha… http://bit.ly/dtd8Nr #
- Dear Dispatch Drone,: I realize that it has been so long since your assimilation into the Collective that you have… http://bit.ly/dvwzv2 #
- RIP, Frankenhoopty: 2000-2010: Sure was a good truck. The search for Frankenhoopty II continues…
Sorry no blog pos… http://bit.ly/aVSKSZ # - A Triage Nurse Not To Be Trifled With: Got this e-mail from a good friend who is a nurse in a major metropolitan E… http://bit.ly/acczc9 #
- Long, Cold Day: Spent the day on my motorcycle, tooling around from one auto dealership to the next, looking for a… http://bit.ly/biAiJm #
- Going truck shopping today. On a motorcycle. In 50 degree weather. With poor credit. Something tells me I'd better bring a tube of KY. #
- We are now 1.5 hours into Lent, and still dealing with drunks. Call me cynical, but I don't think these folks are devout Catholics… #
- It's Fat Tuesday, and my trauma shears are glowing pale blue. Sumdood is on the prowl. Either that or fibromylagia orcs. Whichever. #
- I think I'm working in one of Napolean's original ambulances. Somebody scratched "D.J. Larrey wuz here" on the wall behind the suction unit. #
- Feelings… whoa whoa whoa feeeeellliiinngs… I'm taking requests, people! #
- Ambulance Driver’s Aimless Tweets: Eff. Em. Ell.: Driving KatyBeth home from the Ex Wife’s house last night, I tot… http://bit.ly/bxTC3g #
Lately, seems like everybody I know is dead.
A month or so back, I got a Facebook friend request from the ex-girlfriend of my best friend in high school. I hadn’t seen or heard from her in twenty years, and hadn’t heard from Rickey in almost as long.
Rickey and I were asshole buddies from my sophomore year in high school on, even though we went to different high schools 100 miles apart. We chased girls and drank beer and did all the things teenage boys do, and when we graduated high school, we found an apartment in LaPlace, Louisiana, within easy staggering distance of the local watering holes.
We worked our jobs during the day, partied like mad every night, and sowed every single wild oat that *I* had. In 1986, I was bringing home close to $600 a week, and still I moved back to Monroe close to two years later, broke and with $8,000 of credit card debt.
Rickey, on the other hand, still had plenty of wild oats left to sow. We lost touch with each other, and the last I heard, he had moved to Florida some time in 1989.
Over the years, I tried several times to track him down, but it seemed that he had dropped off the face of the Earth. Last year, I found a few self-published books of his on Lulu. I bought and read them, and gleaned that he’d had some substance abuse problems after we lost touch, and spent a few years in the Louisiana prison system.
Seems he was driving drunk, and killed a pregnant woman. Spent eight years in some very nasty places, doing time for two counts of vehicular homicide. He lost his wife, his three kids, basically everything.
After he got out, he tried to put his life back together, tried to atone for what he’d done, tried to reconcile with his children and become the father he’d wanted to be before he succumbed to drug addiction.
From reading his books, he didn’t have much success at that.
But from reading his poetry and prose, amidst all the pain and remorse, I could still see more than a glimmer of the man he once was. He was vibrant, and talented, and a great friend. Prison had knocked him down, but it hadn’t broken him. He was clawing his way back.
I dropped him an e-mail at the contact address on his Lulu page, but never heard from him. Then, several months later, his ex-girlfriend messaged me, and with a little searching, we discovered his obituary. He died in 2008, apparently by his own hand.
We also discovered his son.
He looks a lot like Rickey did. And he’ll never know the man his Dad was before addiction changed him into something else. Neither will his sisters.
Then, today, I just learned that another friend and former co-worker died a few hours ago. He was my age, perhaps a bit younger. We’d always worried about his weight; he was far larger than I, and hypertension ran in his family. I took care of his father when he had his stroke. But the size of his body was more than matched by the size of his heart. A kinder and more giving man, I have never known.
Yesterday, Thomas had a heart attack at the wheel of his car. He left behind a wife and his first child, barely a month old. She will never know what a wonderful man her father was, save for tales from her mother and his friends.
Requiescat in pacem, Rickey Haltom and Thomas Kaheiki III. You will not be forgotten.
Most of the EMS internet forums have been abuzz lately with the story of the Pittsburgh man who died before EMS could reach him, after his wife called 911 ten times in 30 hours.
As usual, most EMTs who read it were quick to crucify the EMS crew based on nothing more than news reports and public statements from the city’s Public Safety Director.
Turns out, the Public Safety Director may have his own agenda, and as usual, the reporters story left out any facts that didn’t fit the critical tone of the story.
TOTWTYTR has a comment from someone who works in the system who adds some valuable perspective to the news accounts.
Never judge a story based entirely on media accounts, folks. If I had a dollar for every time I read a news account of a call I ran, and wondered if the reporter was actually at the same scene I was, I’d be a rich man.
Accuracy and objectivity is the exception for today’s news media, not the rule.
… mid 90’s Mercury sedan equipped with nine video screens!
It's not the crack habit that makes RP a shaky photographer, but doing without it on duty.
Yes, you read that right. NINE video screens: One on each visor, one on the roof console between those two, one in the headrest of each front seat, a larger screen in the seat back between those two, and three more mounted in the rear seat head rests.
I’m not quite sure of the purpose of the screens mounted in the rear seat. Perhaps they were to entertain the other motorists.
And where was this rolling monument to bad taste and too much disposable income headed, you ask?
Why, to the local charity hospital ER, naturally!
I only wish I were kidding.
I realize that it has been so long since your assimilation into the Collective that you have long ago lost the capacity for independent thought.
I realize that, as a veteran dispatcher, the real world has faded to a gauzy, ephemeral shadow realm nibbling at the borders of that pool of light cast by your computer screen.
I also acknowledge that, as a former street medic, the lobotomy necessary to be assigned to dispatch was not your choice.
But for pity’s sake, man, pull your head out of your ass, you mouth-breathing, monosynaptic, booger-eating dullard.
In the spirit of the post-response performance critique, I’d like to point out that the time to message us with the correct directions to the scene is while we are still on the way, not five minutes after we have pressed the “AT SCENE” button on the data terminal. Because by then we’re, you know, already inside the house, usually trying to explain why we wandered around the neighborhood aimlessly for ten minutes, without coming right out and saying that our dispatcher has the cognitive ability of a garden slug.
I’d also like to point out that the “unconscious 2-year-old” you sent us for is a far cry from the “80-year-old with weakness” that we actually found, both in pathology and pucker factor.
Now, before you blame those mistakes on miscommunication from a panicked caller, keep in mind that I have long experience with your dispatch style, and I spoke to the 911 caller in question. He was calm, and perfectly lucid.
You, on the other hand, have not been lucid since the first Clinton administration.
With companies as large as The Borg, I suppose it is inevitable that we assimilate an occasional intellectually inferior bioform into the Collective. Usually, such a mistake only makes for a momentary “DUHR” ripple through the Hive Mind.
But you, however, are so irredeemably stupid that I cannot help but conclude that, were we to purge you from the Hive, the IQ of the Collective would instantaneously increase to the point that a 911 system and a Dispatch Hive would become obsolete.
We’d all be so smart that we’d be able to telepathically sense an emergency, and the nearest Borg unit would automatically head that way, without the need for directions from the Central Hive.
We’d be totally unstoppable, but for you.
Love and kisses,
Ambulance Driver
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