EMS – Bad for Relationships?
It’s probably no surprise that public safety work from all aspects can have negative effects on relationships. Long hours, mandatory overtime, irregular work schedules and work-related stress can certainly wear on your partner over time. Does this mean that our line of work makes it impossible to maintain a healthy relationship? Absolutely not.
Yes it is true that most ems jobs come with long hour shifts. But let’s not forget that it usually includes more time off. For example, people working 48 or 24 hour shifts usually get stretches of 6 or 8 days off. It’s all of the overtime that we pick up that causes problems in the household. Now I live on private ems pay too and I truly understand the need for extra money. But it must come in moderation. Try not to live outside of your means and make what time you have with your spouse quality time. Being apart from each other can actually have positive effects if it’s not excessive.
We all get irritated when we get held over to run “late calls” or support a busy system. Trust me, your partner feels the same way. The last thing your significant other wants to hear after you have been away for 2 days is that you are not coming home on time. Not to mention the fact that you probably just want relax or sleep for a few hours to recover from your shift. Rather than fight over this, try talking about it and come up with a set of agreements. For example, you can set rules like not making plans immediately after your shift or designating some time for rest when you come home. Now on the occasions that you do come home well rested and on time, you can surpsrise your partner and do something special.
Everyone knows that our line of work comes with its share of stress. High work loads, financial trouble, critical incident stress and desicions concerning promotion or relocation can take its toll on a person. Unfortunately, most of the time we keep it inside. Trust me when I say that it shows, and it can negatively affect your behavior. Always make sure to talk to your partner about stress in your life. Try including them when it comes to important decisions abour your job or your life. Call your partner throughout the day to tell them about your shift and talk about stressful calls. This will keep you on the same page and will allow your partner to have a better understanding of what you are going through. Let your loved one support you. Don’t let your work issues become home issues.
Working in ems doesn’t mean the end of the world for your love life. It certainly isn’t easy. It’s no surprise to me that many ems professionals date and marry nurses, firefighters or other ems professionals. Communication and quality time are going to be your best friends when it comes to maintaining your healthy relationships.
I would love to hear about your stories or experience with relationships and the ems field. Please feel free to comment below or email me.
Field Guides – Crutch or Tool?
Before I even begin this discussion, I am going to come right out and say that I carry an EMS field guide with me on every single call. Now I’m going to spend the rest of this article defending my position on it!
I heard many people argue that field guides or “cheat sheets” are crutches. I can certainly understand how someone could become dependent on having the information in their back pocket. I have heard plenty of stories of medics flipping out after getting on scene only to realize that they forgot their field guide.
I will say that I have been that guy. The first time I forgot to pack my guide, I ran an infant cardiac arrest. Even though I got nervous, I was still confident that I knew my dosages. I treated the kid without delay and the call ran as smooth as it would have if I did have it.
Even if you carry a guide, it shouldn’t replace your core knowledge. You should have no problem figuring out a dosage or doing drug math. Carrying the guide should be a way to double check your work. You shouldn’t have to rely on it 100%.
The popular field guides that are on the market now have tons of useful information. Poison information and prescription drug information are just 2 examples of things that are nearly impossible to accurately keep in your memory bank. Having the information in your back pocket will be extremely beneficial.
My personal favorite guide is the “ALS EMS Field Guide” by Infomed. I never leave home without it. I also carry a nurses drug reference book and a medical dictionary in my backpack. If nothing else, they can be used to research a patient’s medical history and medications during long transport times and learn something new.
In conclusion, I feel that the field guides are a great tool, but can easily turn into a crutch if you don’t stay on top of your core knowledge. The guides should be used to add to your existing knowledge, not replace it.
If anyone knows of any good field guides that I didn’t mention, please let me know. I’m always looking for new tools to use at work.
New downloads section added
I recently added a new downloads section to the blog. Right now it includes a radio report index card and an adult GCS scale card. I am going on vacation tomorrow, but I plan to upload more EMS related cards and a free copy of my e-book when it’s finished.
If anyone has any suggestions or requests for items to add, please let me know.
Sign here please
As I sit here reading through Happy Medic’s Blog, I came across a very interesting post regarding billing, and refusal of treatment. He made some very valid points when it comes to fraudulent practices seen amongst many EMS providers. For the purpose of this post I am going to focus on legal issues when it comes to having patients sign AMA (against medical advise).
The Scenario:
You arrive on scene of a 26 year old female complaining of abdominal pain that started 2 weeks ago. After you start your assessment, she asks you if the ambulance ride is really necessary. You respond by telling her that her vital signs are all stable and that she looks fine. You explain that abdominal pain that started 2 weeks ago is non-urgent and that she should seek care with her primary care physician as soon as she can.
She accepts your advise and decides against transport to the hospital. You then ask her to “sign here” to release you from any liability SHOULD anything happen after you leave. She signs the form, apologizes for calling you out and wishes you a good day.
Here’s the problem with this scenario. You just had her sign a form that states that she is “refusing treatment” against medical advise. Well your medical advise was to stay home and seek care from her physician at her convenience. I’m sorry but Larry H. Parker is going to eat you alive in the court room.
Just because you got someone to sign a piece of paper, doesn’t mean your legally off the hook. Someone signing out AMA must give you Informed Refusal in order for the form to actually be legal. Just like Informed Consent, the patient must verbalize that they truly understand the risks from REFUSING TREATMENT. Tossing them a piece of paper and saying “please sign this” isn’t going to meet that criteria.
As EMT’s and Paramedics, we should not be giving medical advise unless it is in the form of convincing a truly ill person to go to the hospital. The proper way to address the “do I need to go” issue is to explain that it is not your decision to make and that if they want to go to the hospital, you would be more than happy to take them. I’m not saying force everyone to go, because that will get you in trouble too. Just be very cautious when expressing your opinion on their condition. We are not physicians and we cannot truly rule out a life threatening illness.
If you felt so strongly that the patient didn’t need to go, then why did you have them sign an AMA? Why not just leave them and call it good? There shouldn’t be a need to “cover your ass” if they really don’t need medical attention right?
If you want to play it safe, then don’t advise patients that their condition doesn’t require medical attention. That old lady with the stubbed toe just might have broken loose a clot from the DVT that you or her didn’t know she had (a stretch, I know). I’m not saying that you have to force everyone to go, but rather be careful of what you “advise” people before you have them sign a refusal of treatment. Lets try not to give the lawyers any more money than we have to.
Ever seen one of these?
A 10.0 ET tube…….ever seen one?
Don’t get your hoses in a knot
Lately I have participated in many discussions regarding fire-based EMS. As we all know, there are very good arguments to both sides as to whether EMS should be run exclusively by the fire department. So rather than argue about whether or not it should be done, I am going to express my opinion on how fire-based EMS should be run.
Having worked in a single-medic service for my entire career, I tend to favor that type of system. I truly believe that 1-2 paramedics for each call is really all you need. Any more than that and you are just wasting resources. At minimum 1 paramedic on the ambulance would be sufficient. Depending on ambulance availability I suppose having a medic on the engine would be beneficial too. You can refer to my article “Two paramedics are not always better than one” for more on that subject.
I believe that the paramedics assigned to ambulance duty should play a single-function roll. It is very difficult to keep up your skills as a paramedic if your job responsibilities are split between patient care and firefighting. I also say this because I don’t believe that paramedics should have to become firefighters in order to practice in a 911 system.
One big problem with having multiple paramedics on scene is establishing who is in charge. It needs to be made very clear in writing who runs the show. I feel that this responsibility should be given to the transporting paramedic. If they are going to care for this patient all the way to the hospital and have to answer to the doctors and nursing staff, then they should have the final say in how the patient will be cared for.
Being the conservative that I am, I don’t really believe in “special taxes”. Having said that, I do believe that if a community wants to vote to impose such taxes to provide fire-based EMS services, then more power to them. If a special tax is imposed to provide the service, then the department should not be billing the patients. Departments that tax and bill their patients are just asking to be shut down and replaced by a private ambulance service who collects no tax dollars.
I truly do believe that efficient and effective service can be provide by fire-based, third service or private-based EMS, it’s just a matter of doing it right.
And that is why we assess our patients
We get dispatched to a familiar address for “difficulty breathing”. As we pull up on scene, the fire captain walks up to the ambulance and says “he’s having another asthma attack, my guys are walking him out right now”. I wasn’t particularly thrilled with his decision to walk the patient, but at this point the patient was already walking up to the ambulance.
The patient is 67 years old, deaf and has a history of chronic asthma. He typically calls about once a week when he runs out of his Albuterol and gets short of breath. The call started out pretty much just like every other time I have transported him. I’m initially thinking “O2, monitor, IV and an Albuterol treatment and we should be good to go”.
I listen to his lung sounds and hear wheezes in all fields. This is pretty much normal for him as mild wheezes are pretty much his baseline. He happens to read lips quite well, but doesn’t really speak. I look him in the eye and ask, “are having another asthma attack?”. To my surprise he shakes his head “no”. A bit puzzled, I ask “are you short of breath?”. He motions “yes”. So now I start with a different route of questioning.
Sean: Does this feel like your asthma is acting up?
Patient: No
Sean: Are you having pain?
Patient: Yes (and points to his chest)
Sean: Have you ever felt this way before?
Patient: No
So now my treatment plan completely changed from a respiratory emergency to cardiac. I wasn’t able to determine length of time or a pain scale due to the language barrier, but I did know enough to start treating him.
I placed him on oxygen, started an IV and administered 325mg of ASA. His bp was 98/palp so I did not administer nitro. His monitor showed sinus tach at 110 and an Sp02 of 99%. We arrive at the ER, place him in a bed and the staff does a 12-lead ecg. Sure enough, the patient was having an MI and was taken to the cath lab.
This call really got me thinking about how easy it would have been to just run with the asthma idea and completely mistreat the patient. Administering Albuterol would have increased the workload on the heart and potentially made the MI worse. Who’s to say that the hospital would catch the error?
If anyone else has similar stories, I would love to hear it.
If my heart monitor could talk, I would have to shoot it…
The service that I work for recently made a rather large purchase of new heart monitors. We are switching from the Zoll “M” series monitor to the Zoll “E” series. This of course comes with a ton of neat upgrades. Built in c02 Capnography, NIBP, and 12-lead monitoring are all new features that come with the devices.
There is one feature that I forgot to mention…..
The monitors record the Sp02, c02, NIBP and ECG for the entire call. They also have Bluetooth capabilities and sync the entire call to our electronic PCR’s. You heard that right, big brother is coming to town!
Before I get to far into this post, I will say that I am 100% for recording and keeping the data, but I’ll get into that later.
I heard several people say that they are troubled by the new devices because they feel like they are being “watched” or “spied on”. Many paramedics fear that the feature will lead to a lot of “Monday night quarterbacking”, or questioning of paramedics practices if you will. I personally believe that the people that fear this system are just not comfortable with their own skills. I am actually quite bothered by this response and can’t help but wonder if it will have some negative impact on the care provided by the “affected paramedics”.
Ever get the feeling that your being watched? Have you ever noticed that you don’t act like yourself when you know you are being watched or recorded? Well imagine that feeling being applied to every ALS call you run. My fear is that some paramedics are going to second guess themselves to the point where nothing gets done. Unfortunately everyone always assumes that surveillance is a bad thing.
Lets look at an example on how closer monitoring of patient care can be helpful:
Have you had a patient present to you one way on scene, and completely change either en route or at the time you arrive at the ED? If you have, then you have most likely had the nursing staff or the ER doctor question your assessment or treatment. Rather than just saying “you weren’t there”, you can show them solid evidence and spare yourself from being the topic of their conversations for the rest of the day.
ECG recording can be used to improve QA programs, defend yourself in court and help the hospital staff continue the care that you started. Having someone review your calls and ECG interpretation will ultimately help you. It is far better to have someone correct an issue, than let it go without being addressed, and possibly harming someone. If you feel that uncomfortable with your knowledge or skills, then read up and get confident!
Don’t be afraid of big brother. He’s really there to help.
Sunny California…..
Why do I live and work in Southern California? Duh…..the beaches, hot babes, and the sun.
So how the hell did I end up like this on my last shift?
HIPPA vs EMS Bloggers
Yes I’m bringing up the much feared “H” word…..but for a good reason!
I read various EMS-related blogs and Twitter posts every day. Most come with some pretty interesting stories about calls ran. Unfortunately, some are a little too detailed and have the potential to get some people in trouble. I know this because I speak from first hand experience.
Being guilty of sharing my calls for the day with the world, I have been known to give out a little too much information. On one occasion, my boss actually called me into his office because he received a complaint about a story I posted on my blog. Luckily it just amounted to me pulling the post off my blog and no real damage was done. However, had it have been pushed any further, I could have easily been fined thousands of dollars. My employer would have also been fined, which would have probably translated into me being unemployed.
Many EMS bloggers violate HIPPA and don’t even know it. There is a huge misconception that leaving out patient names protects us from privacy laws. The truth is, you have to pretty much leave out any details that could even remotely link the story to a patient. For example; if the patient can read your blog and identify the story as being their incident, then HIPPA has been violated.
So how do I HIPPA-Proof my blog?
The only way to make your blog 100% compliant is to just not reference calls without a patient’s permission. If you read my blog, you obviously know this is not how I practice. I do however, take several steps to minimize my risks.
First and foremost, NEVER use patient names, addresses, pictures, etc. Anything that directly links your story to the patient is just an attorneys payday waiting to happen. Making up fake names or not using names at all is an easy way around this.
We all like to brag about who we work for right? Well don’t do it. Don’t even mention what agency or company you work for. Doing so places yourself and your employer at risk. This goes for the entire blog, not just the story.
Don’t talk about where you work, or even where you live. Be vague when discussing your location. Use terms like “Southern California” rather than “Los Angeles California”. This also applies to the entire blog.
Don’t get detailed when discussing call locations. Describing your scene as “Chili’s Restaurant on 4th street”, is a bad idea. Instead either make up a fake establishment or just don’t even mention any business names.
Blogging is like journalism, so aren’t I covered under the “freedom of the press?”
No, no and hell no.
Sure Geraldo Rivera can pretty much say anything he wants on TV and be covered under the constitution, but Geraldo isn’t a paramedic (thank god). We are healthcare providers and we sign HIPPA agreements when we go through school and start employment. As a matter of fact, posting protected information on the internet is about the worst way you can violate privacy laws.
Don’t get me wrong people, I love reading about how you intubated 2 people at the same time or successfully stuck an IV in someones earlobe. Just please be careful and protect yourself!
If anyone is interested, more HIPPA information can be found at http://www.hhs.gov/ocr/privacy.