No! Bad Job!

Shaq and I are, as we call it, just chillin’ at post, tossing a football. Our magnanimous dispatcher raises us and sends us on our way to a local dialysis clinic, for a report of a “female with chest pain.” We make our way in that direction post-haste when we get an update:

“Med two, your patient is possibly coding, per the facility” comes the message from radio, while the MDT updates with “POSS FULL ARREST/CPR IP”

We have a hard time believing this, mainly because we haven’t run a legit call in at least six weeks, but maybe today is the day.

In the end, it was partially legit. No, the patient wasn’t in cardiac arrest. Yes, CPR was being done, but the patient never lost consciousness. At least the AED was applied correctly. Except there was a nurse doing CPR while the machine said to check for a pulse. And for some reason, she kept wanting to give nitro.

Instead of having a stroke, I decided we would just move the lady to our stretcher. In the process, I figured out what happened: the patient complained of chest pain, and the ‘nurse’ administered nitroglycerin, (probably too much at once, but maybe not) then the patient’s blood pressure bottomed out and the patient had a syncopal episode, at which time the staff panicked and began running around like chickens with their heads cut off.

Admit it, it’s plausible.

As we’re walking out, we hear one of the firemen talking to the ‘nurse.’ “Thanks a bunch, y’all. You guys did a great job.”

Bullshit.

“You’re gonna be here tomorrow, right?”

That’s become the mantra where I work. It doesn’t matter how bad you screw up, or whether or not you are actually competent at your job. As long as you show up on time, you’ll have a place to work.

They won’t fire you if you give the wrong dose of the right drug to a patient, and cause serious complications. No, they won’t fire you, as long as you can make it to a meeting where we can slap your wrist.

Oh, you gave the wrong drug to the wrong patient at the wrong time and the patient died? Don’t worry, that pink slip isn’t your termination notice, it’s your transfer notice. That’s right, they’ll just ship you to another division.

What? You sexually harass your employees and got arrested for beating your spouse? Geez, now they’re going to have to transfer that harassed employee! Don’t worry, though, they won’t fire you. You’ll get a new job title out of the deal, though.

You did what? You called a STEMI because the monitor doesn’t know how to recognize a right bundle branch block, and you activated the cath lab and cost the hospital thousands of dollars? They won’t fire you. Heck, they won’t even give you any remedial training. They’ll just make you transmit all your EKGs to the hospital.

Oh my goodness, you called a patient deceased in a motor vehicle crash without actually touching the patient? And that patient wasn’t actually dead? And another ambulance had to take that patient to the hospital? And you told the patient’s wife that her husband was dead? Don’t worry, they’ll somehow blame it on the fire department, even though the ambulance service is responsible for all patient care.

Yeah, you’re gonna be here tomorrow, right?

Well-earned complaint

Shaq and I are running a non-emergency for a female who is weak. Which means there is absolutely nothing wrong with this woman. This is the same county that requires emergent response to ear aches, so use that when assessing the severity of this call.

According to the notes, she “doesn’t feel good.”

Call me a library book, because I’m already checked out.

We find this lady sitting in a chair in her living room. I wish I could say she was watching Maury, but the television was off. Shaq does all the talking, and we learn that she “doesn’t feel good.”

Chalk one up for the call-takers. Good job, everyone. Strong work.

We move the stretcher a little closer and Shaq asks if she can stand up to sit down.

“Oh, no, I’m just too weak.”

“Well, ma’am, forgive me for asking, but how did you get in that chair in the first place?”

“Oh, I walked here, but that was several hours ago.”

Mind you, I’m still checked out, and I only have vague recollections of what transpired next, but it ended with us lifting her out of her chair and putting her on the stretcher.

“Which hospital would you like to go to, ma’am?” he asks.

“Oh, I have to go to North County, they have my records.”

“That certainly won’t be a problem. C knows how to get there.”

“You guys aren’t going to put me in that…that…room with all those Mexicans, are you?”

“Well, ma’am, I’m not really sure what you mean. We don’t have anything to do with room assignments at the hospital.”

“Well, I don’t want to be in that room with all the Mexicans.”

Then he lets loose. “That hospital takes care of all sorts of people, ma’am. They take care of Mexicans, Indians, Canadians, Africans, Jews, Catholics, Asians, Russians, Italians, Australians, Caucasians, Muslims, Christians, and everyone in between-”

“-that’s not what I meant-”

“-they will even take care of bigoted American women. Now let’s go.”

The rest of the ride was real quiet. And then we got to sit in the supervisor’s office for a little while.

But it worked itself out.

Imagine this

Imagine if you will, an ambulance service decides to make every “patient contact” require either a refusal signature, or a transport. Imagine there is no more “false call,” or “no patient found,” or “no EMS needed” options for call disposition, only a patient refusal or a transport to an emergency room.

Imagine that the service ignored their definition of a patient, which used to be “a person who is ill or injured who requests, or would request, emergency medical attention.” Imagine if that new definition included:

  • People sleeping in cars
  • Accidental medical alarm activations
  • People in car crashes who didn’t request EMS
  • A guy changing a flat tire
  • Passengers on a school bus which struck a mailbox

Imagine being told by dispatch to chase down a guy in a grocery store who was sleeping in his car, waiting for the store to open.

Now, imagine if you will, the ambulance service issues “report cards” to their employees, and one of the categories in which they are evaluated is their “Transport/Refusal Rate.”

Imagine that your yearly raise is directly tied to your “Transport/Refusal Rate.”

Imagine how angry you might be.

Lame excuses

My employer runs a paramedic program. When I say that the company runs a paramedic program, what I want you to take away from that is that the company supplies a physical location for a paramedic program, and students to fill the chairs.

But, they attached the words “EMS Academy” to it, so maybe it is sorta-kinda-official.

Whatever. It’s a moot point.

My employer runs a paramedic program.

Being one of the company’s Field Training Officers, I get to see the aftermath of the paramedic program, when the newly graduated paramedics spend several shifts riding with me. Some of them aren’t prepared, but most are.

I was having a talk with another FTO, Tony, while at the hospital a few days ago. This must have been early in a shift, because I actually cared about the topic.

Tony mentioned that he rarely sees the same paramedic student more than twice, and that each student does at least twenty rides at our company. He thought it would be wise for a student in our paramedic program to be ‘assigned’ to an FTO for the duration of their preceptor rides.

While we’re on the subject…our program is putting paramedic students on ambulances for their preceptor rides after three months of school. They don’t know how to read a monitor, and they aren’t allowed to perform any ALS interventions. What the hell is the point of riding for twelve hours on an ambulance if you can’t do anything?

Anyway.

Tony made a good point. After ten rides or so, there should be a pretty good rapport between an FTO and a student. They should be able to communicate openly with each other, so the student can get the most out of their classroom time, and their ambulance time. After twenty rides, any bad habits should be corrected, and the FTO can feel confident in his evaluation of the student. Alongside the FTO’s confidence in his evaluation, the course director can feel confident in the evaluations he gets from the FTO.

But instead, the students just ride whenever, and wherever. Rarely more than once with the same paramedic, or even with an FTO.

So Tony and I brought it up to the director of the program.

“Assign each student to an individual FTO. We have twenty-five students, and eighteen FTOs. Surely we can come up with a list of seven competent medics to fill the roster of needed FTOs. Once a student is assigned to an FTO, that student does all of their rides with that FTO. It only makes sense.”

We got a reply:

“Well, that would just be too hard, and we don’t want to make it any harder on the students.”

This is why I don’t care.

Lame-ass excuses.