General Discussion | Paramedicine 101

Outcome Data

10/14/2010 by Adam Thompson, EMT-P 6 Comments

“It is imperative that we obtain the diagnosis and treatment outcomes of our patients, or else good treatment decisions will mean no more than the bad treatment decisions, and the ignorant medics will remain ignorant”

- Me

What do I mean by that?

Many hospital systems have decided that it is a HIPAA violation to provide patient outcomes, and diagnosis’ to prehospital agencies.
Without this information, there is no way to provide information about how a paramedic’s treatment may have benefited or harmed a patient.

Are the hospital systems right?

The simple answer is NO.

As part of a QA/QI process, all information may be disclosed from the receiving hospital to the transporting agency. Under the QA/QI umbrella, HIPAA has no baring. Furthermore, the treating physician for that patient is, initially the medical director for that transporting agency. If one physician transfers a patient to another physician, they are more than entitled to that patient information. There is no difference between a physician in a hospital whom transfers out a patient, and a medical director whom oversees a paramedic. THEY ARE BOTH THE TREATING PHYSICIANS. They both deserve the right to know what happened to that patient. The medical director can then use that information for the QA process however he wishes.

What is the benefit of having this outcome information?

Imagine ignorantly treating the same symptoms the wrong way. Information about your patient’s outcome could inform you of this mis-treatment, and you could then make the appropriate changes.
Now imagine an entire EMS agency treating the same types of patients the wrong way. Outcome data could show trends in beneficial or detrimental treatment outcomes, and the appropriate changes could then be made.

So why the reluctance?

The first reason is ignorance – the hospitals just don’t know that this information is just as much ours, as it is theirs.
The overwhelming reason is presumably the reluctance to display their own poor performance. Hospitals will keep their save rates, door-to-balloon times, botched surgeries, and other information that may alter the money they make or fork out, under lock and key if they can.

So what can we do?

I am leaving this answer up to my readers. Any attorneys out there who have taken this on? Any supervisors or managers who have sat at the table and come up with a plan of action? LET US KNOW.

Please comment on this, and get the discussion going…

Filed Under: General Discussion, Legal

EMS Educast Episode 67

08/26/2010 by Adam Thompson, EMT-P Leave a Comment

Greg Friese from EMS Educast invited me to guest cohost on episode 67. On the show was David Page from the St. Paul EMS Academy.

Make sure to go check it out.

Thanks for stopping by,

Adam Thompson, EMT-P

Filed Under: Education, EMS EduCast, General Discussion

Need Your Help

08/15/2010 by Adam Thompson, EMT-P 3 Comments

I am looking for help with the following projects:

Paramedicine 101 Podcast
Interactive Educational Software

I am looking for sponsors for the Podcast. Please contact me at Paramedicine101@gmail.com for pricing and advertising options.

I am also looking for software developers to assist me with the creation of something I have been working on. It would be an interactive presentation/educational program. Assistance with this would gain you commission on any income made.

Last but not least. I am looking for an artist/illustrator. Someone, preferably with experience illustrating the human anatomy.

Contact Adam Thompson at Paramedicine101@gmail.com

Filed Under: General Discussion

Show Me Your Rig

08/14/2010 by Adam Thompson, EMT-P Leave a Comment

On the Paramedicine 101 Facebook page, I am asking the readers to show off their ambulance. Maybe we can get to know each other a little by gawking at the trucks we drive. Go post a picture of your chariot.

Filed Under: General Discussion

I am not a cretin

08/12/2010 by Adam Thompson, EMT-P Leave a Comment

Back during EMS Week, EMS1.com held a writing contest. Kelly Grayson, AKA Ambulance Driver called on us EMS bloggers to make submissions. The theme was Anytime, Anywhere, We’ll be there. I am not sure who one, but the top 6 can be seen here. Below is my submission. Enjoy…

I am not a cretin

I am but a mere individual amongst a whole world of professionals. I am a thrill seeker, but not the kind that jumps off cliffs with a self-packed parachute attached to his back. I am educated in my craft, and I do it well. Many, even with my hard earned five years of experience, could still consider me a rookie. I am an educator, but not a professor. An expert, but not a scientist. A manager, but I lack a work force. I’m not an athlete, actor, or politician, but I believe I make a difference. I am a paramedic.

As a paramedic, we make many promises. Some are simply shrugged off or overlooked. “I promise I will take care of your father to the best of my abilities”, or “I promise, just one little poke”. Some of these promises are ever so important, but understood without ever having the need for verbal explanation. Anytime, anywhere, we’ll be there. Now that’s a promise.

911, the one phone number that you can call and pretty much expect an answer on the other end every time — excluding a few flukes. Jimmy Noolan was hoping that was the case when he dialed that number from a payphone outside of a 7-eleven. You see, Jimmy doesn’t get too many voices talking back to him on the other end of calls he often makes. His wife and son tragically left him prior to him being ready to let them go, as if he could ever be ready for that. He chose to drown his pain with his buddy Jack, and built a pretty strong relationship with ‘ole Jack. His drinking problem weighed heavy on his life, and what remaining family members he had, simply gave up on him. Out of a job, family, and home, Jimmy like so many, took to the streets.

A man who seemingly cared so little about his own life had called 911. But this isn’t the first time. Jimmy happens to be, what I call a repeat offender. He calls often, usually with the chief complaint of loneliness, hunger, or cold and wet syndrome. Thought by many as a burden to our already busy EMS system, and unfortunately treated as such all too often.

The tones drop back at the station and the call comes in, Medic 7, respond to the 7-11 for a possible heart attack. My partner and I look at each other with grins and scowls due to the premature diagnosis made by our illustrious dispatcher. We know it isn’t the dispatcher’s fault, but give us the symptoms, and let us tell you what it is. We also throw the possibility back and forth of this just being another transient at a payphone — of course keeping the worst possible case scenario in the back of our heads. This is a training truck, and we have enjoyed the three-person crew all day, running these calls smoother than our freshly shaved faces.

We don’t kill ourselves getting there, taking the lights and sirens response easy. If anything, it will give the local fire guys time to practice their BLS skills. We already had our dinner in us, and there was no rush to get this over with. As we pull up, the red truck with the flashing lights gave us a good idea where the patient was located. A group of well-trained, firefighters were huddled around what looked to be a patient. A familiar face was finally visible as we approached, and I could hear my partner whisper “oh gosh, it’s Jimmy”. Yep, there he was in his usual getup, a tattered dirt-stained blue flannel and similarly filthy ripped jeans with his sock-less feet in a pair of unlaced brown construction boots.

The firefighters gave me the typical report: “O2, aspirin, and vital signs, he wants to go downtown.” Going downtown was fine with me, it was right around the corner from the station, and they were use to Jimmy by now. Sure, it isn’t a cardiac facility, but this was Jimmy, not a real patient — right?

We packaged Jimmy on the stretcher, and wheeled him to the truck. My partner hollered up front to our EMT, “downtown, kill the lights”. Something happened at this very moment, something I had heard of, but never experienced. My gut was disagreeing with my lackluster treatment. Another glimpse at Jimmy told me something was wrong. He was seemingly pretty sober. He was not his normal sad, and lonely self. He was scared, and from the looks of his pale, damp skin, he was sick too! I gave my partner a look only understood by fellow EMS-ers. He asked what was wrong, and I replied, “Just let me get the 12-lead done before we start heading that way”.

Sure enough, Jimmy was having an anteroseptal myocardial infarction — or a heart attack represented by ST-elevation in leads V1 thru V4. Looks like the dispatcher was right. The face on my partner when I showed him the ECG was indescribable. Pucker factor had now set in due to us being behind the ball. Humbled, a new gear was locked in, and our treatment strategy quickly changed. Obviously, so did our destination. STEMI center, here we come, only thirty some-odd minutes to go.

On the way to the hospital, new modalities were added to Jimmy’s usual treatment of choice — compassion. Jimmy went into a short-lived lethal arrhythmia during the ride. Luckily Jimmy had the paramedics that he called for, not those guys that were about to take him downtown. He was quickly stabilized with our new sense of preparedness. We activated the cath-lab to facilitate quicker treatment on the way. Had two IV lines in him, some nitroglycerine, and a little morphine.

I held Jimmy’s hand and told him he was going to be okay. Something I had told him so many times before, only this time I think I was listening to my words more than he was.

Jimmy had a massive occlusion to one of his coronary arteries. He underwent cardiac angiography and recovered well. It was a longer road than usual to the cardiac hospital that night. I thank God for that moment of realization, without it; his lifesaving treatment would have been delayed. I haven’t seen or heard about Jimmy since, but I am sure he is still around, and you better believe that the next time he calls — anytime, anywhere, we’ll be there. Only this time, without any preconceived notions — because I am a paramedic.

Names and events have been altered to protect the patient’s privacy.

Filed Under: General Discussion

Videos: Kill some time

07/08/2010 by Adam Thompson, EMT-P Leave a Comment

I’m going to be on vacation for a week, in Chicago. In the meantime, here are some videos to kill some time. I am not responsible for the content.

Filed Under: General Discussion, Humor

ClinCon 2010

07/02/2010 by Adam Thompson, EMT-P 2 Comments

Hello to all of our loyal readers. It’s Adam here and I am sorry for the long periods of nothing to read. It was that time of year again, and I was preparing for the ClinCon conference. If you are unfamiliar with it, head over to their WEBSITE.

The reason this takes up so much of my time is because I am part of my agency’s ALS competition team. We compete in these scenario-based competitions. It’s somewhat of a game. Imagine the worst possible call you could ever run, and multiply that by five. That tends to be the types of scenarios the sadist that come up with the challenges think up.

This was my fourth year competing at ClinCon and my team had remained winless. There are two days of competitions with some of the best teams in the country competing. On the first day is the preliminary round, which every team competes in. A team is made of three crew members, and one alternate whom usually holds the video camera.

Preliminary scenario

Bus crash:

The first five minutes was a START Triage scenario which required each team to go through a number of cards that included patient type and vital signs. Each card had a number and you had to assign a color (red, yellow, green, or black) to the corresponding numbers.
We are then rushed in, to what is deemed the yellow treatment area. Within this area was a mother holding a baby, and a patient complaining of burning eyes.
A good sample history and assessment uncovers the cause of the burning eyes which is chlorine. The patient also presented with wheezing.
The baby was who was actually a green, was not suppose to be re-triaged, but kept with mom instead.
The mother ends up having hypertension, and then postpartum eclampsia. Her seizures would persist until Magnesium was administered.
At about the ten minute mark, another patient presents. He is nearly unresponsive, and shows signs of a cardiac contusion and cardiac tamponade.

Treatments they were looking for:

Rapid full-body assessments on every patient.
Re-triage all patients red.
Flush eyes of chlorine exposed patient
Treat wheezing with bronchodilator
Once wheezing subsides rales present – treat with Lasix or CPAP
Treat Eclampsia with Magnesium Sulfate
Recognize pericardial tamponade

Treatments we did:

Got 100% of the assessments
Flushed eyes of chlorine exposure
Provided high-flow O2, then albuterol, the nebulized Sodium Bicarbonate.
Recognized the low acuity of the baby and kept it with mom
Treated mom with benzodiazepines then Mag.
Recognized Beck’s triad & electrical alternans (cardiac tamponade) and performed a pericardiocentesis.

So we didn’t do exactly everything that they were looking for. Even though we completely resolved the tamponade, there were no points for the percardiocentesis because they said “no one does that”. Um, we do. In fact, all arrest thought to be due to blunt force thoracic trauma receives three needles in their chest. One of them in the heart.

We were concerned that the other 40 teams would have done better and we wouldn’t make it into the top five this year. This concern subsided once we saw the results. We got second over all and made it into the finals once again. Even though, this is just a scenario-based competition and not a real sport, there is a lot of pride. These teams that compete in these challenges take it very seriously and are impressively good. We were thrilled to have done so well.

The Finals

Political rally:

The bus that crashed in the preliminaries was to be headed to a political rally that set the scene for the finals. The finals are performed in front of a live audience at the venue. Prior to entering the scenario, each team was shown a video. It is of the political rally, and portrayed a possible explosion.

Three initial patients.
A room filled with picket signs and full bottles labeled dihydrogen monoxide
A single black box about the size of a shoe box was present in the middle of the room.
First patient was in V-fib arrest, and had a dialysis shunt. CPR was being poorly performed by a distractor.

A distractor is any actor in the scenario that is not a patient. Dihydrogen monoxide = water.

Second is a patient with an avulsed eye from a possible explosion.
Third patient presented with an open mandibular fracture and signs of traumatic asphyxia.
At about 4 minutes, a fourth patient presented. He was yelling and deaf. He had signs of bilateral perforated tympanic membranes, or eardrums. He was yelling that his neck hurt.
At about five minutes three more patients walked in with burning eyes from being maced.

Sounds easy right? Well in twelve minutes it is a very stressful and high paced incident.

Treatments they were looking for:

Scene control
Assessments for every patient
V-fib arrest patient is to be defibrillated into a PEA
After PEA is present they expected you to determine hyperkalemic cause and administer sodium bicarbonate and/pr calcium chloride.
The eye avulsion only required BLS care
The traumatic asphyxia required a cricothyrotomy within five minutes.
Obtain SAMPLE history from deaf guy by writing it down
Flush the eyes of the maced individuals
DON’T OPEN THE BLACK BOX

If you opened the box, you became exposed to chlorine gas and had to flush your eyes before you could do anymore treatments. I am not going to go into the details of how every team performed or what exactly we did. All I am going to say is WE WON.

That’s right, Lee County EMS, my team, got first place this year. So bragging rights are ours for the year, and then we will return for the competition once again. There are many other similar competitions to this throughout the country and I will be on EMS Educast this month to talk about them a little more.

So I am back and will be getting back to posting more often. You may have noticed the new look of the site. Tell me what you think. I am hoping to make the move soon to FIRE-EMS Blogs.

Filed Under: EMS EduCast, General Discussion

Empathetic vs. Pathetic

05/28/2010 by Adam Thompson, EMT-P Leave a Comment

Empathetic vs. Pathetic

Listen up EMS

By Adam Thompson, EMT-P

I know I have pretty much kept this blog purely aimed towards education, fact, and evidence. It is time for a rant though.

Please read the following links before continuing:

So what do we do? How do we change the attitude of our fellow EMSers? Do we need to make the change, or do they?

This is something I have been cognizant of for some time. Being an overachiever in EMS gains you no friends. The more successful you are, the bigger your blip is on the radar of ridicule. But who cares, right? They aren’t talking about you for being a cretin medic that screws up on calls.

Example. I am a young, but experienced medic. I have achieved a lot in my career. I am a published author. My training captain recently sent out one of my articles with a thumbs up message to my entire agency. The response was as good as it was bad. The ongoing joke is with every conversation I bring up I hear “why don’t you go write an article about it”. Some of this may be just a joke, but I can feel the animosity from many. Why?

The Problem

I think, from my experience I have pinned down one problem. We are our own bosses.

I know we all have bosses, chiefs, supervisors, what have you. What I mean is, most of us don’t have those people on our trucks with us. If you work in a system like mine, you may be the lone medic working with an EMT, or maybe you are the EMT. I think that the systems that have multiple medics per ambulance suffer less from these issues–and here’s why.

If you are use to making your own decisions with little repercussion and the ignorant feeling of correct-fulness, you will not likely be inclined to take advice from your fellow medics. I dread the response of a peer that I attempt to assist with a smidgen of education. Because there is a naive belief that they know EVERYTHING.

Why are we so damn sensitive?

If you haven’t read my letter to the new guy, go read it. It is time we toughen up. If a salesman isn’t making a company any money, are the bosses going to be fearful to approach him?

I was speaking with one of the white shirts (officer) from the training department the other day and made some proposals. I said we should have a real QI/QA committee that picks ten calls at random every month. Some ran good, some not so good. Then, the medics on each of those calls would have to present each case in front of their peers. There would be questions and answers.

My thought was that we hear about the bad calls through hearsay all the time, but do those medics get to defend themselves on a normal basis–no! A lot gets lost in translation. Sometimes you have to be on a call to understand, right? Well here is the chance to remedy that while implementing a QI/QA process that physicians use and grow from.

His response: The union will never allow it.

What the hell are we doing to ourselves? While unions might be established to protect the best employees, why do they work so hard to keep the worst? We can learn so much from each other, but you can’t learn if you keep thinking there is nothing left to learn.

We all mess up. Get over it!

I consider myself a pretty educated paramedic. I have made many mistakes.

Now think about that. When do you learn most? I’m not saying that there is a cemetery somewhere, filled with all my mess-ups. I’m talking about simple, little mistakes. Mistakes that if unmade, would have lead to more information and a faster diagnosis or better treatment modality.

If you think you are invincible, go ahead and continue living on your beachfront desert property. You make mistakes too.

If you can learn so much from your mistakes, and I can learn so much from mine, why can’t we BOTH learn from EACH OTHER’S mistakes? This of coarse requires a deflation of bulbous craniums.

When did this stop being about the patients?

Empathy is a virtue that is quickly finding itself on the endangered attributes list.

Please read Professionalism: What we say by me.

No matter what you read here, or believe. No matter how long you have been doing this. No matter how bitter you are. You have to agree that at some point of your career you wanted to help people. You wanted to make a difference, and do some good. So I ask you this… Are you?

Filed Under: EMS 2.0, EMT, General Discussion, paramedics

EMS Week 2010

05/18/2010 by Adam Thompson, EMT-P 2 Comments

Happy EMS Week everyone!!!

In the comments, please provide your most memorable experience from this last year of being an EMSer.

The following video was something provided by (the old) Rocky Mountain Medic. He was a fellow EMS blogger, and wanted this shared for EMS Week.

Filed Under: General Discussion

Improving AHA

05/16/2010 by Adam Thompson, EMT-P 4 Comments

Those of you who follow the Paramedicine 101 Facebook fan page may have noticed a discussion, after this post was shared on the wall. A follower mentioned the AHA Learn: Rapid STEMI ID course, and how it could be a solution. Myself, and Tom B then casually shared some choice opinions about video-based AHA courses. I recently received an email from the commenter, who happens to be affiliated with the AHA. He humbly asked if he could call me regarding my ideas. I suggested a conference call with Tom, and he suggested a conference call with the people whom make decisions at AHA. If we do get them to take interest, I would like to be able to provide a lot of insight. I have many ideas, but would like to solicit some more from our faithful readers.

How do you feel AHA courses could improve?

- ACLS

- CPR

- PALS

- Rapid STEMI ID

Please provide any suggestions. This is our chance to make a difference. RM, don’t hold back.

Filed Under: Education, General Discussion

Outcome Data

EMS Educast Episode 67

Need Your Help

Show Me Your Rig

I am not a cretin

Videos: Kill some time

ClinCon 2010

Empathetic vs. Pathetic

EMS Week 2010

Improving AHA

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