Friday, November 30, 2007

The award for most ridiculous medical procedures in a drama goes to...

...Law and Order: SVU "Paternity"

I normally don't take TV shows seriously. I like the Law and Order series. It is always relaxing to watch a good psychotic murderer at 10:00 pm to wind down from a long day.

I tuned in this past Tuesday night (11/28) and saw a nanny murder with a side dish of infidelity, paternity issues and a botched murder-suicide. This only took 40 minutes. What could happen in the last 20 minutes? The worst medical procedural scene I have witnessed in some time on television, that's what.

Elliott Stabler's wife (pregnant, full-term) is being driven to a doctor's appointment by Stabler's partner, Detective Olivia Benson, when they are t-boned by a drunk. During the ensuing rescue the police detective (played by Mariska Hargitay) climbs back inside the wreck and starts an IV under the direction of a FDNY medic. She doesn't just start an IV...she starts an IV from a position an experienced medic would cringe at (but do). Then, without instruction, she tamponades the vein. The medic then hands in a small bag of fluid and instructs Benson to "squeeze the bag." She does, but rather than squeeze and hold the bag she performs this rhythmic squeezing thing that miraculously brings the patient back to life.

It is fortunate that she was brought back because she was then able to push like a fiend to get that baby out in the moving ambulance (sans stretcher straps) on the way to the hospital. Like we would want to intentionally deliver a baby from a woman with internal injuries, in a moving ambulance, alone.

Not surprisingly, she does easily deliver the baby (two pushes), who arrives in the world as all TV babies do (clean, without an umbilical cord, APGAR=10 and crying for mommy). Also without surprise, the patient loses consciousness again after delivering the baby.

I know it is a cop show and this was alleged drama but you really have to see it. If you have a PC you can watch the episode online. Or just watch the last 20 minutes. If you do, please leave a comment here to tell me what you thought.

I suspect that some (if not all) of the FDNY personnel portrayed in the episode were actually FDNY. My sincere condolences to you for having to participate in such dramatic fluff.

Remember when Johnny Gage started the IV on himself in the hose bed of the engine after being bitten by the snake?

Those were the days.

Monday, November 26, 2007

Just when you thought you knew the AHA CPR guidelines...

It looks like more changes will be coming in the future. Studies--and the newspapers touting the results--all seem to point to doing even more compressions and fewer ventilations.

Compression most important in CPR, an article from the Houston Chronicle, reports on a presentation at the AHA sessions in Texas this month. A 50:2 compression to ventilation ratio reportedly improved survival significantly. Devices like the ResQPOD as well as hypothermia seem to also be quickly rolling down the pike.

What I find most interesting--and even refreshing--is movement away from blindly and fanatically following CPR guidelines. In years past you would've had all those cool patches ripped from your sleeve if you one-one-thousanded when you were supposed to one-and-two-and. Gasp!

This reminds me of an article I saw this summer from Wisconsin, Simplifying CPR, saving lives. I like these guys. Do compression only CPR to the tune of "Another one bites the dust?" Sign me up.

Is this medical heresy? Anarchy? Revolution? No, its maturity. We finally realized that guidelines are, well, guidelines.

It looks like I will soon get to add another item to the "things I was trained to do that we now know kills people" list: ventilations. It will have some great company. Stabilizing trauma patients at the scene, gallons of IV fluid, bicarb... Ah, the good old days.

Sunday, November 25, 2007

EMS in paradise--and the training is free

18% of the EMT positions in the city of Honolulu, Hawaii EMS are open. To remedy this (apparently sun and surf alone aren't enough) the city is offering paid EMT training. The string attached: you must work for two years after training.

City's offer: Get paid to become a Honolulu EMT

Before you sign up you should know the EMT course in Hawaii is 420 hours. If you would rather take the course on your own for college credit it can also be taken at the Kapi'olani Community College. The EMT course is 20 credit hours.


Saturday, November 24, 2007

Real Life EMS

I shot the photo you see on the right while riding with the Portland Fire Department MEDCU. I liked the photo because it was a slice of real-life EMS. Not blood. Not guts. Not dramatic. Just real life EMS.

It has been my contention for some time on this blog that EMS is about taking care of people. Finding the pleasure in simple moments with a patient will keep you vital in EMS when there isn't enough trauma, sirens and excitement any more.

I submitted this photo to an EMS magazine for consideration for cover placement. No go. I'll admit that it isn't the most dynamic photo. But it is real. And it is a moment.

Are we being fed a diet of excitement when in fact we really nibble on routine call after call?

I took the rejection relatively well. Then I thought more about it. Maybe I should create my own magazine: Real Life EMS. Imagine what would be between the covers of this magazine every month.

Imagine no longer. This blog will frequently host covers of Real Life EMS Magazine. The magazine covers you will see are a combination of satire and commentary. I'm sure you have experienced more than one of these situations during your real life EMS experience.

Here is the first cover. Click on it to see a larger version. Enjoy!

Monday, November 19, 2007

And you thought YOU were having a bad day...

At least you're not this crew from Durham Region EMS in Ontario, Canada:

Ever loose your narcs and RSI meds?

Fortunately a citizen turned them in to a pharmacy who called police. Durham Regional EMS was quoted by the Durham Region News saying:

“Our thanks go out to the local resident and the pharmacy for their vigilance in noticing the container and contacting police so quickly,” said Richard Armstrong, the director of Durham Region EMS. “While this is an isolated incident, we continually review our procedures to ensure that proper protocols are in place to help safeguard against such occurrences.”

What else can one really say? I wonder what the conversation was like in the rig?

"Do you have the narcs?"

"I don't have the narcs. I thought you had the narcs."