Faith vs. Medicine

Back when I was in high school I was an extremely active member of the Island Heights First Aid Squad.  Summertime was no exception.  I spent many days when I was not on the water on the ambulance running calls.  One call just before the start of my senior year of high school is a memorable one, and I was not even on it.  I think now more than ever though, it bears mentioning. There was a rather serious traffic accident on the highway that ran next to our town.  Due to a shortage of daytime crews, just like many other days, our squad was called upon to respond.  The patient was a middle aged male with shortness of breath, and belly pain.  Since he required extrication, the decision was made to fly him to the trauma center rather than drive him. From what I was told then, and can better comprehend now, he was hypotensive and had a significant amount of internal bleeding.  As with any other trauma patient in a similar condition, he got two large bore IV’s, and a boat load of fluid as he was transported by medivac to our regional trauma center.  The area of New Jersey where I was raised was very small, and through the grapevine, word came down that after his arrival at the trauma center he had passed away. We were told that due to the patient’s religious beliefs he refused a blood transfusion.  Because of his depleted volume and the seriousness of his internal injuries, without the assistance of blood products the trauma team was unable to save him. The reaction from some of my fellow EMT’s was one of sadness and anger.  Many could not understand how this man could possibly put his religious beliefs and his expectations in the afterlife above that of the life that they had worked so hard to try and save that late August afternoon.  But that is what he wanted, and the trauma center was willing to honor and respect it. A few weeks later my squad held an in-service in which they had someone of the same religion come in and answer questions about the how’s...

Preparation and Response

Preparation and Response

Apr 16, 2013

First of all I want to send out thoughts and prayers to everyone involved in yesterday’s explosion at the Boston Marathon.  It is a shame that we live in a world where we even have to deal with these incredibly tragic events, however, they also show the resilience of the American people.  We will recover, and we will overcome. In the wake of yesterday’s tragedy one thing I think everyone needs to realize is how lucky Boston is to have the men and women of Boston EMS caring for the people of their city.  In the days leading up to the Marathon, the Boston EMS Twitter was extremely active talking about the immense amount of preparation leading up to Monday morning.  From the looks of it they were ready for almost anything.  And kudos to Boston EMS for sharing that fact with the world. If nothing else, those of us in the EMS community need to walk away from this with recognition of how important preplanning is.  None of us should ever take for granted our own personal safety or the safety of any event that we cover.  No one should ever utter the words, “that will never happen here.”  Instead, take the extra time to draw up a detailed plan.  Know your staging areas, know your egress routes, and make sure that every single provider involved is aware of them as well. Another thing that needs to be pointed out that I think many people not involved in public safety lose sight of rather quickly is while this large response was going on in Copley Square the rest of Boston was still calling 9-1-1.  Boston EMS, Fire, and Police were just as busy as they were on Sunday, and just as busy as they will be today.  In my eyes, that is one of the most remarkable things about incidents like this.  Not only does the public safety community step up to deal with a major crisis at hand, they also continue to handle those routine emergencies that so frequently flood communities. While watching the news, I saw a number of different ambulances down at that scene: Cataldo, Lifeline, McCabe, AMR, and Professional...

A Look Back at a New Facility

  I was cleaning out my phone the other day and I found some pictures that I took back in November before I left Massachusetts.  On December third of 2012, Baystate Medical Center opened its new emergency room.  In the weeks prior, they were inviting paramedics and EMTs from the area to come and take tours so they would know a little more about the facility before it opened.  I attended one of these tours, and took a few shots. First of all, I have to say that the facility itself was beautiful, and while I always liked Baystate’s old ER, it was a clearly an upgrade.  While this was close to six months ago, and I am sure some might feel that the pictures would have been more relevant a post then, as I reflect back on them the staggering thing about them to me is the actual status of the emergency room when I took the shots. Much of the ER was ready to go, and probably could have taken patients that day but the place was empty.  Patient rooms were vacant, no one was in any of the nurse’s stations or pods.  Everything in their trauma room was neatly put away, and in two week’s time it would never look like this again. Baystate can be a pretty chaotic place.  As the only level 1 trauma center west of Worcester, and the region’s premiere STEMI and pediatric center it was constantly full and many times overcrowded.  To see this brand new state of the art ER completely empty was a sight to behold. In the months since it has opened, the transition has seemed to go relatively well, at least according to some of the folks that I have spoken with about it.  That is not at all surprising to me considering the quality of the nurses, doctors, and staff that work there.  Still though, kudos to them.  ...

Response Times and ROSC Rates

Response Times and ROSC Rates

Apr 2, 2013

First of all I would like to make it clear that what you are about to read is largely driven by my own opinions based on what I have read, and what I have seen in my years both as an EMT and a paramedic.  With enough research though, I feel confident that I could present a substantial amount of “facts” to back this up. Response times DO NOT improve ROSC rates. Directly. In article after article about response times, there is always that little asterisk that says “in MOST cases response times do not matter.”  Well, I am going to go as far to say that in ALL cases response times do not matter.  There are far more important things than response times in providing a high quality Emergency Medical Service.  I say specifically Emergency Medical Service because Skip Kirkwood made a terrific point in his comment in a recent blog post: “(An) ‘ambulance service’ is not the same thing as ‘EMS.’” Now, let’s just suppose for a second that we go with the common statement that response times improve outcomes.  An ambulance pulls out of their station or away from their street corner and goes flying across a city, or through suburbia, lights and sirens blaring, and they pull up in front of the address of a patient in cardiac arrest.  Then what?  If that ambulance makes it there in 8 minutes and 59 seconds or less, do the EMS gods simply smile, say “job well done!” and your patient is magically resuscitated?  No.  Far more goes into it than that. So if response times do not improve ROSC rates, what does make a difference?  Well, let’s start from the beginning: 1.  Public CPR education – Seattle has proven that when trained, people are willing to help.  The rest of the country should follow their example and push public education.  That does not exactly mean putting a CPR card in the back pocket of every citizen, it might just mean educating them on the importance of compressions only CPR. 2.  Public access AED’s – Again, here is another piece in the pie that rests mainly on the public.  Since I have been...

That’s All She Wrote!

. . . And I have a picture to prove that this is not an April Fool’s joke. Twelve years as a Massachusetts paramedic.  As tough as it was to let it go, I had to do it.  That National card is in my pocket now though, which is quite the feeling of accomplishment.  If I had one piece of advise to give anyone getting into this field, or anyone who is already in this field, get your National Registry certification if you don’t already have it.  It’s worth it. But I digress. . . Thanks for a great twelve years, Massachusetts!  Best of...