Pure Pretense


Pure Pretense

By Thom Dick Feb 05, 2013

You’re responding with an ALS engine to the rural home of James Colbert, an 80-year-old guy whose wife has called 9-1- numerous times for shortness of breath. James’ cardiovascular system is a train wreck; and sure enough, you arrive to find him in fulminant pulmonary edema. Not only is he struggling for his life, but he appears exhausted. He’s gray, he’s diaphoretic, his head is bobbing, he’s oblivious to questions, and you can hear him gurgling feebly across the room, 60 times a minute.

Craig, the engine company medic, has been on scene for 11 minutes when you arrive. But he has no vitals, no ECG, no history, and nothing to say about his observations or his activity. There’s no O2, no IV and no CPAP. He makes no effort to help you with your gear as you enter. Instead, he stands between you and Mr. Colbert with his hands on his hips. You try to be polite and somehow still get past him, so you can get the old man into a sitting position.

“We were wondering what took you so long,” he says, in front of the family. “This man’s pretty sick.”

(Ya think so, Craig?)

You’ve played this pathetic game so often, you’d really like to meet somebody at NBC. About two years ago, your fire chief clamored to get into the paramedic biz and spent a ton of public money to put medics on “his” engines. (Only he doesn’t live in the district, so he doesn’t own so much as a lug nut.) And there’s nothing medical about the medics. All they do is get in the way. They don’t assess, they don’t treat, they don’t transport, they don’t write charts, they don’t read the literature, they don’t respond to QI inquiries, and they don’t even handle their own restock (‘cause that’s your job.) When they do attend CE, it’s never off duty. Even then, they’ll sign in. But they’ll take off at the slightest rumor of a car fire or a smoke alarm—and not return. On scene, they act like super-medics, appointed to oversee and approve your decisions, all without the benefit of any actual medical expertise on their part. It’s pure pretense. And no one, not even your medical director, ever confronts them about it.

Q. It seems nobody ever brings this up, but it’s a problem, and it’s really been worse since 9/11. I’ve already left two good systems to get away from it, and that hasn’t helped. Isn’t there some way to fix it?

A. I know you’re smart enough to have tried the first solution to every team issue; and I can probably guess what you’re going to say. But it’s important. Please, please, if you haven’t already done so, talk to Craig first. He deserves to know how he comes across and how you feel about it. If that doesn’t work, document this and every occurrence for someone who has a little more collar brass than either of you.

Q. You don’t understand. The whole system works this way, and it’s like the engine crews are being told by their officers it’s their job to supervise us.

A. Actually, I do understand. I know what you’re dealing with is no fun, and I don’t blame you for leaving other systems to get away from it. No medic worth their salt wants to be constantly second-guessed by people who don’t know their medicine or don’t care about it. But this won’t get solved right away, it won’t get solved by you alone, and it won’t get solved as the result of a single instance. The solution really is consistent, persistent dialogue about anything that’s not good for sick people, conducted as honestly and as respectfully as possible. If you’re not part of the solution, you’re part of the problem.

Q. I know I can’t fix this by myself, but it’s like the Big Red PR Machine can do no wrong. I’ve complained many times in the past, and everybody just shakes their head and shrugs their shoulders. What makes you think documentation is going to change anything?

Continue Reading

A. See, I think there’s a difference between chronic complaining and consistent advocacy. Complaining is lazy; advocacy is work. But none of us is omnipotent. I think we just have to keep on trying.

And never, ever give up.

Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com. 

Pink Heals Inc. is a national program that partners with public safety groups and communities to show cancer patients they are loved.
Neilson Rizzuto, who injured 32 people after driving drunk through a crowd at a parade, was released on good behavior.
Battle of the Badges is a community event to acquire much-needed blood donations for the local hospital.
When a victim is injured, sick, or in need of help, religion, politics, and conflict become lesser concerns.
Firefighters and EMS personnel are playing against police officers to raise money for a fire captain battling cancer.
Lakeland Fire Department hopes their camp will encourage young women to join their crew down the road.
Five Tempur-Pedic mattresses were donated to several departments to ensure firefighters receive quality sleep while on shift.
The tournament is a fundraiser for the Michael A. Winson Memorial Foundation, which gives $850 scholarships to EMT students.
Hannibal Fire Department members taught fire safety and firefighting skills at the Kids in Motion camp.
Walker County Emergency Services will use the Public Safety Foundation's grant to purchase thermal imaging cameras.
Fourth through seventh graders met at the North Mankato Fire Station to learn about tourniquets, splints, and the dangers of drunk driving.
The best case for assistance is seeing United Hatzalah volunteers in action. 
The monument is a steel beam from the World Trade Center and will be the only memorial in the country dedicated solely to EMS personnel.
Pasco County Fire Rescue crew members laid sod in Gene Work's yard so he wouldn't be heavily fined by his homeowner association.
A study shows a 13-15% increase in survival rates for patients who received treatment from an AED outside of the hospital.