I hate being ambushed.
The other day, I was having what I thought was a private IM conversation with a kid who’s interested in EMS. He’s not a bad kid; he’s excited about EMS and can’t wait to start his EMT-B class. However, he wants to change the world of EMS.
Good for him, we all have to have some lofty goals to shoot for, right?
Oh, did I mention he wants to change the world of EMS RIGHT NOW? With no absolutely EMS experience? He’s not an EMT. He’s never ridden on an Ambulance. Never touched a patient. Never been puked on or shit on or called an asshole by a patient he was trying to help. No experience.
Now, this kid is also enamored with the King County Medic One system. I know that some people think it’s the bee’s knees. I, having worked BLS in King County, am most decidedly NOT enamored with KCM1. Frankly, I think it sucks. That’s MY opinion. And, it’s valid because I’ve been part of both BLS and ALS level patient care there. I’m just not a fan. That’s a post for another day. Maybe.
This kid is also a fan of the “EMS 2.0” movement. Great. I’m all for making EMS a “real profession”. Should every prehospital care provider be degreed? Yep. Should we raise the standards for paramedic education? Yep. Agree and agree.
Here’s where we disagree. It’s my opinion that sick and injured people deserve prehospital paramedic level medicine, even if they’re not circling the drain. Sorry y’all. That’s how I feel. As an example, I think pain management is a huge issue that medics in King County will not touch. C’mon guys, It’s simple, fractures and other ortho injuries should have their pain managed by ALS providers. That’s what I believe. I think it’s what a caring, competent medic should do.
The kid replied, “In my opinion prehospital pain management is unnecessary because in ten, twenty, or thirty minutes the patient will be in the emergency department.”
Seriously? When your grandma is lying on the cold kitchen floor with a hip fracture following a fall, I hope you are there to explain why she’s not going to get any pain meds prior to being seen in the ED. Oh yeah, it’s because you believe that pain management isn’t important and we shouldn’t “waste” an ALS unit on something so insignificant. Seriously.
Timothy, I called you an idiot in my IM conversation, and that stands. I also stand by the statement that you need to gain some experience in the field, even as an EMT, before you start to judge what is right and wrong with EMS today. You need to see sick and injured people before you can make blanket statements about treatment modalities.
Earlier today, I was pretty pissed when I saw that this kid took a private conversation we had and turned it into blogfodder, than I remembered he’s just a goofy kid sitting at a PC in his mom’s basement typing away… and I realized I don’t give two shits about what he thinks.
I am an EMT.
Today we were to transfer a severely mentally retarded 50 y/o female to a SNF. She was A&O X 0, gcs 7, contracted extremities. although she could not speak, we could see she was in great pain when we tried to move her or her extremities so she could lay on our gurney. We asked the nurse if she could give her some relief for the bumpy ride ahead. she was being discharged after “months” at the hospital, yet it appeared the nurse knew very little about the pt.
The nurse only offered tylenol rectally, which wouldn’t have given her the immediate relief the pt needed. she had weak excuses for not giving her something better.
The Nurse and nurses aide treated this pt like a piece of meat. A very sad situation. We felt horrible we could not help her more.
My personal code is to see every Pt. as my mother, grandmother, father etc.
I wish Timothy could see the patients we deal with and he would change his mind very quickly.
Medic 22, thank you for taking the time to write your side of the story.
I was very very wrong about the amount of time it takes to get pain meds in the ED. One study showed it takes an average of 75 minutes after triage in the ED to get pain meds.
“As an example, I think pain management is a huge issue that medics in King County will not touch.”
KCM1 paramedic Michael Damm at King County Medic One has been trying to bring pain management to South King County for 11 years to no avail.
“Sorry Kevkei, I forgot to address your last paragraph “DAMMEDIC, Although your MD may be correct that nobody has ever died from pain, I must say they are not a patient advocate and I am curious if they would say the same thing if they or their family were picked up and didn’t receive adequate analgesia. It’s always okay for them as long as they aren’t the one affected.”
I can’t agree more with you! I have been battling this topic for 7 years to no avail. At one point we had our agency MD on board yet the other program MDs in the county voted against it! Again, “nobody ever died of pain” was just one reason. Another was/is the potential abuse issue, especially with fentanyl compounded by the fear ketamine could be stolen off the trucks by youngsters for their Rave parties. Subsequently, our patients receive a proper induction via etomidate but very infrequently the administration of diazepam and morphine post intubation (only a few of us religiously use the agents). What you end up with is a patient who doesn’t remember undergoing paralysis and intubation but wakes up being paralyzed and intubated on a bumpy ride to the hospital.”
“He’s never ridden on an Ambulance. Never touched a patient.” Since when is doing CPR during a Medic One ride along not considered touching a patient and not riding on an ambulance?
I have been a patient requiring pain medication twice in the past two years. On one occasion I arrived at the ER in profound pain (in Orlando while on a business/vacation) and thankfully I was wearing a traded FD shirt (not my own department’s), she said, “Oh we take care of you guys FAST” and within a few minutes, I was indeed well-taken care of.
On the other occasion, I went to the ER that I have taken patients into for the last 28 years as a Paramedic (and at one time, the Asst. Chief of EMS Operations) and the new nurse on duty didn’t know me and I waited well over an hour. To say that I was ready to kill the guy would have been an understatement. I know it was early in the morning and I hadn’t shaved, but I don’t think I looked the part of the “drug seeker”.
Had I called 9-1-1 in Orlando, given the professionalism of the personnel I have met there, I am sure I would have been taken care of, as I am positive I would have in the same situation here in my own community where our department can provide analgesia under standing orders.
While I can say I am positive that in either case I would not have died from my pain, I can also assure you that one more minute in either situation is not something I would wish on my worst enemy, much less my beloved wife, children, or other family members. We have the tools, the training, and the competence to alleviate suffering. It’s our job. Our controlled meds are securely locked and assidously accounted for and it seems to be working, along with random drug screening and most importantly, reliable and professional personnel who I consider worthy of public trust.
Consider the reasons why you want to deny the tools to the people who work for you, then ask yourself, “are we trying to cure society’s evils, block the efforts of drug seekers to find a supply, or save money by denying patients pain management”? If so, that’s not a reason to make patients wait for the meds. That’s an issue that can be controlled with other means, notably: secure storage, appropriate procedures, and ethical, professional personnel.
And yeah, before anyone decides to change the system, maybe they need to live it a while first. And no, doing CPR on a Medic One ride once in your life does NOT qualify you for that honor.
Sorry. The “kid” (Timothy ?) doesn’t bring anything to the table except enthusiasm. There’s a lot of enthusiasm among new recruits. So we don’t really have a shortage to worry about.
The kid shouldn’t have posted an IM conversation on a blog and really should know what he’s talking about before disagreeing and making such a huge deal about the difference of opinion.
It sounds like the kid is just echoing sentiment overheard from KCM1 staff and regurgitating it.
It’s hard growing up in EMS and learning the lessons of life that should have been learned as an adolescent, but everyone’s gotta start somewhere.
“He’s never ridden on an Ambulance. Never touched a patient.” Since when is doing CPR during a Medic One ride along not considered touching a patient and not riding on an ambulance?
I’m sorry, I have to comment on that last sentence, it escaped me the first read through.
Riding along and doing a monkey-skill like CPR compressions does not contribute to your knowledge base that is required for you to contribute in a meaningful way to the “pain-meds or no pain-meds” discussion.
If you think I’m mistaken in this assessment of your real-world accumen, then you don’t get it, and it might take longer for you to “get it” than someone else in similar circumstances. You don’t seem to realize you don’t know what you don’t know. That is a scary place to be (probably not scary for you, but for everybody else).
As a rider on an ambulance you are a guest. You have no responsibility whatsoever, except to stick to one of the medics so as not to get left behind.
As a rider you’ve never assessed a patient or been held responsible for everything that goes on in the confines of the ambulance. You have to provide no documentation, no justification, no adhereance to protocol, no interaction with Medical Direction. In truth, you get a free ride at someelses risk. If you screw up, its all on the medic “hosting” you in his ambulance for not dealing with your mistake.
Even if Medic22 is mistaken about your level of “experience”, you’re still hugely, enormously underprepared to debate this with anyone else, except a fellow student. It was your mistake for posting this in a public forum and to your folly.
Since when is doing CPR during a Medic One ride along not considered touching a patient and not riding on an ambulance?
Does it matter? He’s still got no perspective.
Rob I agree with you. Medic 1 thinks they are the bees knees. I think you know where I stand on that one!
Timothy your response made zero sense. Maybe I am missing something?
Riding along and doing CPR once is a lot different than having actual experience. I recommend that you get some actual work experience and then come back and we can talk about it. It will require you to get much better test scores then you did in my class.
Tim, unfortunately what you have proven is that KCM1 is an agency that is afraid to let their medics treat, not that they are the best in the country.
Doing CPR one time and having a few ride alongs is not the same as working the streets. I’m sorry.
I added to the discussion, medicthree.com
Thanks for chiming in M3. I’ll admit, I did get a little hot over this topic, but I find it frankly insulting that Timothy can criticize ALS patient care without any experience. The Zofran for nausea or Morphine for pain are two simple ALS procedures that we can and should use to care for our patients. Thom Dick said, “they don’t remember your medicine, they remember how you made them feel.” If we treat all of our patients with compassion, treat them as if they were family, then we are always doing the right thing.
“Tim, unfortunately what you have proven is that KCM1 is an agency that is afraid to let their medics treat, not that they are the best in the country.”
I now understand that KCM1 isn’t all it’s cracked up to be.
“they don’t remember your medicine, they remember how you made them feel.”
Great quote. Remember to say that the next time a kid in his mom’s base basement says prehospital pain management is waste of time.
Im on medic 22′s side on this. Im a basic in a rural medic unit that is paired with the local fire district. There have been too many time where ALS has been needed for life support (chokings and cardiac issues) and as well as pain management.
A particular time was when a guy had his leg broken, caught and pulled part way into a hay baler. Now the extrication took a little over a half an hour and life flight wasn’t available at that time. It is a forty minute drive running code 3 to the nearest trauma center in Portland. Without ALS this guy would have had to go over an hour in excruciating pain as we basically had to man handle his leg out of the baler
What about ice packs and proper splinting prior to ALS pain management. While I am all for pain management, I mean I am a huge advocate for it. If a BLS truck is closer to a closed Fx patient in a tiered system, I don’t believe delaying transport in leu of an ALS unit is appropriate. Depending on the pain level of coarse. If moving the patient will cause an increase in pain, I agree with you. If it is a closed ankle Fx, I believe the EMTs can handle them.
Tim, unfortunately what you have proven is that KCM1 is an agency that is afraid to let their medics treat, not that they are the best in the country.
Doing CPR one time and having a few ride alongs is not the same as working the streets. I’m sorry.