Case Study #1

You respond to a street corner for a teenager in respiratory distress.  You find a 16 year old male sitting on the base of a light post having obvious trouble breathing.  He is 6'2" and 105 lbs, a "beanstalk" by his own description.  You exam findings are as follows:

• Alert and Oriented to person, place time and events
• Airway is patent and self-maintaining
• Breathing is 26/bpm with intercostal retraction and tripoding.  
• Lung sounds are clear, slightly diminished on the left
• Pulses strong, regular at a rate of 108 bpm.  He is slightly pale, but otherwise unremarkable.

His history is as follows:

• S: Shortness of breath
• A: Penicillin
• M: None
• P: A "lung problem" when he was 10.  He doesn't recall what was wrong, but it's not asthma
• L: Ham and cheese sandwich about three hours ago with a coke.
• E: He was horsing around with friends, shouted at one of them, felt a pop in his chest then became short of breath.
• P: Came on as described, relieved partly with rest
• Q: "It's just hard to breathe"
• R: Slight pain at the site of the pop, but no radiation.
• S: 2/10 for the pain, 8/10 for the trouble breathing
• T: "About five minutes before they called" (Total time 15 min)
• I: "I sat down and it was a little easier to breathe"

He is placed on the stretcher, and assumes the tripod position, even after being started on 100% Oxygen. His skin becomes slightly more pink on the ride to the ER.

What is your impression of this patient?  

"I Wield a Giant Caduceus"

This one goes out to everyone who has uttered the words, "these new guys don't know <insert expletive>".   The "dumbing down" of EMS education has been a huge gripe since I have been doing this.  However, I ask the question- where did YOU learn this knowledge that you claim the new guys don't get?  Undoubtedly, much of your EMS knowledge came from those who came before you, who also complained that YOU didn't know <insert expletive>. 

One of the coolest concepts I ever heard with regard to original EMS courses was told to me by my partner James- EMT classes prepare you to pass a test that allows you to learn to be an EMT.  It is the duty of field providers to teach people the things they need to know!

For those of you so concerned about the dumbing down of EMS- have you seen the advances in the BLS scope of practice alone?  When I first started, the idea that an EMT would ever be allowed to given MEDICATION was foreign.  Now, we are giving epinephrine, aspirin, albuterol, etc.  Who would have thought even ten years ago that paramedics would be performing therapeutic hypothermia in the field? Some hospitals still can't!  Evidence-based medicine is giving us a lot more tools- CPAP (which will probably be a BLS skills), capnography, etc.  and "traditions" are being debunked.  It's great to see doctors participating in EMS research, and taking a truly active role in development of prehospital medicine.

However, the most important thing is the provider, who must always be willing to teach the new guy, not complain about them. We must participate in wielding the giant caduceus- making a constant commitment to improving the way prehospital care is done on our truck, participating in continuing education, and staying on board with the advances being made.  The information is out there- and some of it is in our heads...find it and share it before saying the people you work with don't know <insert expletive>.  Just like you learned EMS from those before you- now it's your turn to teach!  Just make sure you teach it right.

"Highly Qualified Instructor"

I have spent much of my "time off" from work trying to figure out how I am going to use my background and education in the future.  Admittedly, getting hit my a car and the realization that it could have been worse has kickstarted my desire to move along out of field work as my full-time job.  I came across a request for a "Highly Qualified ICS Instructor".  I always chuckle at these things, because we are all highly qualified in something...so this request made me ask the question- what makes someone a highly qualified instructor?

Is it experience?  Is it education?  Is it the ability to teach?  Is it alphabet soup?  I have known many people over the years who are excellent clinicians who absolutely stink at teaching, and vice versa many excellent instructors that weren't the best at the job.  I have also met highly educated and "qualified" people with every letter under the sun after their name...who were incapable of sharing the wealth.  So what makes a "highly qualified instructor".  This particular job description went on to add you had to meet this standard and that, but said nothing about results.  How about a less "qualified" instructor with a 98% pass rate?  How about one whose students rave about them?

I am a person who does prescribe to education and getting credentials.  I have often joked that the only letters I couldn't put after my name were K and Q, but I also believe it is all meaningless without being able to convey knowledge to those learning from you.  Over the past year, I have had the pleasure of teaching my first solo EMT class and being given the opportunity to become more involved in training at work- but the biggest reward here was seeing the knowledge "click" for people- which often happens at different paces.  I find no greater joy in teaching than seeing people "get it".

To me a "highly qualified" educator is a person who can hand the student the information, guide them to use it correctly, and relish in the outcome.  To be able to do this, one needs knowledge, experience, and interpersonal skills- not just a certificate!

New Year's Resolution-2012!

A lot of people make New Year's resolutions- losing weight, eating healthy, not cheating on their spouse, getting a new job... etc.  I have never much prescribed to this practice, believing that MOST resolutions are like campaign promises- they start strong then fizzle out!

However, for 2012- I have made a resolution: to spend more time providing medical care than receiving it.  2011 started for me with pain from an old back injury.  In June, a patient's actions caused a sprain to two of my fingers.  In August, I had a bout with Lyme disease.  In September, I was in an ambulance accident.  In October, I was hit by a minivan and broke three bones, my pride, and spent just about two weeks admitted to facilities.  In the same week in December, I had food poisoning and kidney stones...

I actually think, unlike the typical campaign promise, I can follow through on this...and yes it involves another resolution- to work on myself and my own health and well-being...who's with me?