David versus Goliath

When I was a police officer there was a noteworthy homicide trial. The top prosecutor went up against a poor, minority defendant who acted in his own defense. The prosecutor lost. Not because of anything he did, it was because the jury felt sorry for the defendant. A classic David vs. Goliath scenario.

David vs. Goliath is a classic story--only now it seems to involve Bryan Bledsoe and NAEMSE. And Bryan Bledsoe is no ordinary David.

Previous posts on this blog have discussed the NAEMSE/Bledsoe situation. It continues. I received the following email from Bryan last night:

To all:

I have received a letter from the NAEMSE attorney in regard to this email I sent in anger. Thus, I must respond:

1. I am not involved in planning or developing another EMS organization nor have I been although it has been suggested by others. I will remain a member of NAEMSE for now.

2. The former NAEMSE webmaster who contacted me and offered material about elections and defamatory emails about me evidently came about these illegally and thus I must retract the statement that an affidavit would be submitted.

3. I would not compromise any contractual relationships between anybody and NAEMSE. First, I do not have that power and do not have that interest. The NAEMSE attorney has accused me of that but has not submitted any evidence to that effect. I have not contacted any vendors or sponsors, never intended to, and have no plans to.

I have attached a copy of the attorney letter if anybody is interested. I will attend the NAEMSE meeting in Hollywood to staff the Brady booth and attend meetings. I will evaluate my need to attend future NAEMSE meetings on a case by case basis. This will end anything I will say in writing or orally about NAEMSE henceforth.

Thanks

Bryan Bledsoe

The email also contained a copy of the letter from NAEMSE's attorney, Pantelis T. Papazekos. Click on the letter to read it.

Disclosure time. I know Bryan Bledsoe. I write for the same publisher. I also realize that by posting this letter I am potentially furthering Bryan's stand.

So what. I think NAEMSE flubbed this one. They threw gasoline on the fire rather than letting it smolder out. They could have taken a high ground. Weathered the storm. Stood on their good intentions. Instead they moved themselves into a defensive position. And it isn't becoming.

More and more people are questioning the intentions of the organization. Why are my dues paying $400/hour to consult attorneys and write letters when NAEMSE should be concentrating on fixing what is broken?

I believe there are many people telling NAEMSE what is broken. Is NAEMSE listening? I guess I'll find out if I get a letter from Pantelis T. Papazekos.

Classroom safety

I was working with our facilities maintenance person about getting defibrillators installed at the college. The facilities guy is very nice, extremely dedicated and has an attention to detail (and attention span) that can't even be imagined by the average EMS provider.

After finishing the defibrillator conversation he was telling me how much he had to do this summer. Many of our classrooms can only be locked from the outside with a key (they don't have a lock button on the inside of the handle). In the wake of the Virginia Tech shootings all classrooms now will have doors that lock from the inside. We will also have shades on every classroom door with a window.

I am sure we aren't the only school thinking about this. Undoubtedly most are. Maybe this will change some of our marketing:

"Quality education. Ballistic protection."

or signs entering the campus:

"This campus has gone 127 days without a lost-time shooting."

Sad the way things happen. Any other campus prevention strategies or training going on out there?

The devil is in the details...or is it?

I recently had some comments from instructors and students about material in one of my books. I researched the answers, consulted with Ed Dickinson, our medical editor and replied to the queries. I always enjoy and appreciate these comments.

It was after I replied that I began thinking about a bigger picture. Let me explain.

The first comment was in reference to how many weeks a woman is pregnant. One source said 37 - 40 weeks while another was 38 - 42. Which was correct? The answer: pregnancies are "scheduled" to last 40 weeks from the first day of the last menstrual period (LMP) until birth. Some babies come early, some come late. A (very) few are born on the due date. Not an exact science. We use the 38 - 42 week numbers to reflect this fact.

The next question was in reference to flail chest. The book states a flail chest is 2 ribs broken in two or more places. The reader asked if it should be three or more ribs broken in two or more places. Good question.

This is what the trauma sources say:

• Lippincott trauma manual says 2 or more in two or more places
• Tintinalli and Rosen say three or more in two or more places
• The Mattox trauma book says "severe thoracic injury causing paradoxical motion of chest wall segments has been termed a flail chest."
• emedicine.com says three ribs broken in two or more places
• trauma.org says two ribs broken in two or more places
• PHTLS 4th says two or more adjacent ribs in two or more places

That's about as clear as mud isn't it?

The last questions is: Why do we say that we can suction for no longer than 15 seconds? Another good question. The most likely answer is that the longer we suction the more hypoxic the patient gets and someone thought 15 seconds was a good guideline.

But the real questions is: What happens if a patient vomits for 20...or 30 seconds?

These three issues actually leave me with a larger concern. How do we get our students and practitioners to think critically when we present (and test) very concrete facts? Lets look at the three questions again from a field perspective:

Pregnancy - the EMT asks how far along the patient in apparent labor is. 24 weeks (holy crap) 36 weeks (early but do-able) 42 weeks (really uncomfortable overdue mom).

Flail chest - is the segment unstable and interfering with breathing? Do we care--or even have the time to count--how many ribs are broken?

Suction - This patient won't stop puking. If I keep suctioning he's hypoxic. If I don't suction and start bagging I push the yuk down his throat and he dies in the ICU later from aspiration pneumonia. (The point: some patients die despite our best efforts to save them.)

These questions from instructors and students are real and necessary. There is an urgency to know these facts because they may be on exams. No one suctions or treats a flail chest unless they get the EMT card.

Do we need the 15 second and two/three rib rule or can we be more practically oriented? Do students and new EMTs need concrete rules or can they apply concepts and consequences under pressure?

Can we test without these exact numbers? Are they necessary facts or traditions that holds us back from better clinical thinking?

Enough for today. Add a comment to tell me what you think.