Friday, May 30, 2008

Lack of contract is driving Boston firefighters to prostitutes

I love these catchy blog headers. What surprises me is that the Boston Globe didn't use it when publishing this article.

A Boston firefighter was arrested in a prostitution sting in Dorchester, MA. As far as I'm concerned he's no different than any of the other five men arrested in the sting. Unfortunately, the Boston firefighters have been getting hit pretty hard in the press.

In this case, I think the Boston Globe actually used restraint. Check out this quote from the Boston Firefighter's Union President:
Edward Kelly, president of the firefighters union, said he didn't know Herelle but thought the incident could be a sign of stress from the contentious contract dispute between the city and the firefighters.
"I think that the pressures of working without a contract are beginning to manifest in the darndest ways," said Kelly, president of Local 718.

I want to make a few things clear: I am a fan of firefighters. This firefighter certainly deserves his day in court. But what was Edward Kelly thinking when he said this? Will anyone is Boston feel sorry for the firefighter without a contract, standing on the edge--only a prostitute between him and psychosis--when he made almost $100,000 last year?

The days of the indisputable firefighter/hero post-9/11 are over. People are fighting to keep their heads above water and pay the bills. We will all need to work harder to justify our existence.

Especially the Boston firefighters when they make statements like this.

Monday, May 19, 2008

EMS under fire

Have you ever sat and watched a news-style lambasting of a hospital for suspected clinical errors and wondered how long it will take for suspected EMS errors to get the same big billing?

Wait no longer.

This video piece from the Fox station in the Cleveland area put local EMS squarely in the sights--and will put a chill in your spine.

The sad part is the only defense that could be offered by the EMS agency is: our care was acceptable...and our documentation was wrong. I felt badly for the department spokesman. It is a good thing the news stations don't know what a code summary is. Be sure the plaintiff's attorney will.

As bad as the piece is, it could've been worse. Those interviewed gave stock answers and tried to give EMS providers the benefit of the doubt. Yet the investigation by the TV station was unusually thorough and appeared to include access to hospital records.

This is sad all around. For the patient, family and EMS providers.

Is this where I should say Happy EMS Week?

Is CPR modern day bloodletting?

Dr. C. D. Hardison, an Emergency Medicine physician from Tennessee, seems to think so. In a letter to the editor of Emergency Medicine News Hardison relates CPR as the modern day equivalent to bloodletting.

In this letter he states:

Death is inevitable. None of us escapes it. Our obsession of saving every life at all costs has become something beyond absurd.

While this letter brought some nasty comments from a CPR/BLS listserv recently can we totally disagree with Dr. Hardison? Would any other procedure that was so profoundly unsuccessful--even though there is nothing to technically lose in resuscitating a dead person--be supported in medicine? His point about the amount of time and money spent obtaining and maintaining alphabet certifications for these profoundly poor outcomes is eye-opening.

The truth is we're still too Johnny and Roy to give up CPR and AED. Don't worry. And I don't believe we should in many circumstances. Comments and points-of-view like Dr. Hardison's are necessary as we work toward evolutionary changes in the expectations of society and realities of medicine.

I personally applaud Dr. Hardison's letter as a necessary step in this process.

Tuesday, May 13, 2008

Another medical helicopter went down this weekend

The Capital Times of Madison, WI posted breaking news about the crash of a University of Wisconsin Med Flight helicopter and the sadness that has enveloped the medical community there.

The Winona (Minnesota) Daily news posted video footage of a press conference and of the crash site

One interesting comment found in the Madison paper is from the owner of the ship that went down:
Craig Yale, vice president of corporate development for Air Methods, said using night vision goggles would be an asset for helicopter pilots, and the company has a commitment to outfit all 350 aircraft it owns with goggles, and make the necessary modifications to the aircraft, over a five-year period.

"We want to get them into all of our aircraft but the logistics of taking aircraft out of service to outfit them with the equipment takes time," he said.

Yale said the company is two years into the five year night vision goggle plan.

Another problem is availability of night vision goggles.

"The availability is real low, because most of the goggles are going to Afghanistan and Iraq," Yale said. "Everybody is trying to get them as quickly as they can."

The issue of helicopter safety is a hot one. We'll be hearing more about this. For now though we should grieve. This article about Mark Coyne paints a portrait of a fellow provider, a passionate educator--and even a Jimmy Buffett fan.

I'll raise a Margarita glass for Mark Coyne, and for Dr. Darren Bean and pilot Steve Lipperer. All made the ultimate sacrifice.

Sunday, May 11, 2008

National EMS Memorial finds a home

The Gazette of Colorado Springs reports that the National EMS Memorial's Tree of Life has found a home in Colorado Springs, Colorado.

The Tree of Life was housed at the To the Rescue Museum in Roanoke, Virginia until closing recently. A committee was formed to determine the new location. For those unfamiliar, each EMS provider who has died in the line of duty is memorialized in a leaf on the Tree of Life. A memorial service is held each May when provider's names are added to the memorial.

I have posted previously about the Muddy Angels who hold a fundraising bike ride to the service each year. A wonderfully noble effort to bring attention (and funds) to this important project.

Can anyone offer help to a fellow EMSer?

I received this email from someone I met at an EMS conference in Salt Lake City, Utah.

Mr. Limmer,

I enjoy hearing you every November in Salt Lake. My wife and I had a child four months ago and he has been hospitalized since. He was diagnosed with a motor neuron disorder. We are trying to get him home but live in a "no service area" for home health care companies. We trached him after many unsuccessful attempts coming off the vent. To make us a family again it is going to require us finding a vent. Kemmerer's hospital is willing to take on our child they can't afford a vent. We are even looking for a refurbished one. Do you know of anyone that could help us? Our boy is currently on a LTV 1150 and doing great. If you could help I would greatly appreciate it and look forward to seeing you this November.


Lenn Johnson
Cokeville, WY

It is a great conference out there with some wonderful people. This family needs some help. I've seen the readership for my blog grow around the country. Can anyone help Lenn and his family?

Saturday, May 10, 2008

Are we ready for 'the new normal?'

You may have seen news stories on the train that was quarantined in Canada because of a potential infectious disease outbreak. This article looks at the incident from the pubic health side and should be a wake-up call for the future of EMS challenges to come. The article states:

But public health officials say it was the type of rapid reaction needed to detect and contain future SARS-like outbreaks. Further, they said this kind of lightning-fast response to clusters of unusual illnesses is actually a sign the system is working.

"Had we had that high level of suspicion in Toronto, for example, at the beginning of SARS, they may not have had the number of cases they subsequently had," said Dr. Perry Kendall, British Columbia's chief medical officer of health.

"So I think it's important that this is the new normal. And I think we will have events that turn out not to be events as we try and screen for events that might be events."

Are we prepared for this type of event? We spend quite a bit of time on hazmat and terrorist situations (which may surface as cases like this) but we don't associate with our public health responsibilities as much as we do our public safety responsibilities.

It is a classic resurfacing of the "Is EMS healthcare or public safety?" question. The answer to this question won't be offered in this blog (at least today), but one thing is certain, we will be forced into our public health role whether we are ready or not.

Tuesday, May 6, 2008

A different approach to assessment: poetry

I had the good fortune to meet Paul Liebow, MD last May at an EMS week dinner. He is a passionate and committed physician and a very interesting man. He gives much to EMS.

In one of our subsequent conversations on books, photos and writing he offered to send me some poetry he has written. I'd like to share some of his work with you.

Just Listen to the Patient

In five minutes you will either know
What’s probably wrong or you may
Later that day, or you won’t.

Listen to Death whispering as it
Tiptoes in behind the woman
Who pushes the huge, protesting
[Too much!] man through
The hissing ED doors.

“I’ve got chest pain but its not my heart!”
So we coded him for two hours-
Every drug by every route
Know to medical science-,
Shocked him over and over.
He walked out of the hospital
Two weeks later.

“I’ve go the same thing my brother had”-
And eight other brothers-
All pipefitters in The Great War
Who chain-smoked Camels
The Army gave out as “rations”.

“You can do anything you want to me-
Treat me with anything you like-
Just don’t tell me I have cancer!”
She did and we did just as she said-
She died at Peace- her family beside her.
Of course they all knew.

“He was fine last week”
The whole re-united family agreed-
Though the poor shriveled up man
Had laid mumbling and contracted
For years in the fetal position.

“I know she just has a headache,
A little fever, and a beautiful smile-
But her sister had meningitis
When she was little”

If you see a mile long list of symptoms,
Tests, and specialists, and they’re now
“Here to find out what’s really wrong”-
You won’t ever know
Unless you immediately do.
And if you let them know they’re O.K.
Be ready for the complaint-
“The Dr. didn’t care about me-
The Dr. wouldn’t listen to me”

But if they are “never sick”-
With even the strangest complaint-
You had better be
Very, very sure it’s nothing-
Before you just write a prescription.
“I feel like my head is going to fall off!!”-
Because the rheumatoid arthritis has
Eaten away their odontoid process-
The last little bone between the
Cervical spine and the base of the skull”

“I’ve been on the Internet-
And I know I have “---”
Take them very seriously-
Get the best scientific article you can.
Give it to them, and they’ll be happy
Whether they do or don’t have it-
With a good referral
And a few simple tests.

In five minutes you should know:
“Live or die”
“Sick or well??”
“Admit or send home??”
“STAT tests or refer now??”
“Will I know before they leave the ED?”

It will still take an hour
To ask all the other questions,
Look and listen, feel and smell-
Answer all the phone calls,
Do all the paperwork,
See all the results.
But you won’t be disappointed-
And neither will they.

Thank you, Dr. Liebow

Monday, May 5, 2008

Childbirth is a natural process

We tend to get worked up when delivering babies in the field. We just don't do it a lot. If we ever need a reminder of just how naturally a birth will go without us present, read this story:

Girl carries secret baby to hospital, still attached

It certainly reinforces the fact that we really don't deliver the baby. We're only along to help out a bit.

More on public opinion

I posted some photos last week demonstrating how what we do is in the public eye. People form opinions on us based on our actions both on and off calls--even on and off the job.

An editorial in the Boston Globe demonstrates what happens when public opinion starts to swing in the wrong direction.

While I have great respect for firefighters--and love the City of Boston--it seems a perfect storm is brewing against the Beantown Jakes.

The post-9/11 high opinion of firefighters seems to officially be over. People who make half the salary of these firefighters can't pay for gas, food and home heat. They aren't going to be sympathetic, especially with the volumes of bad press the fire department has received.

It is time for a change. An image makeover. And, yes, some concessions. I am truly sorry to have to say that. Without public support the political clout once possessed by the firefighters is gone.

The tide has turned against Boston's bravest. Its is up to them to do the right things to get it back.