I am trying to make things better.
Should I take the attitude that “It’s just a job, why care about it?”
Should I not point out things that I see as dangerous?
“You go, Captain! We don’t need to worry about icebergs. We’re unsinkable!”
The captain is the medical director.
The medical director has the most control over the quality of care.
If these decisions are left up to someone else, the decisions will not be focused on medicine.
Medical care directed by non-medical personnel will not be good.
We need for medical directors to understand EMS. EMS treatment is significantly different from treatment in the hospital. Anyone who does not understand this should not be directing prehospital medical care.
It isn’t about looking good in fancy imitation police uniforms, but about providing appropriate care to the patient.
It isn’t about who has the biggest, or the loudest, or the fastest, or any of the other superlatives.
It is about providing competent patient care.
If you cannot provide a medical director, who understands EMS, who has the time to appropriately oversee medics, who is appropriately paid for the medical direction, then you cannot afford ALS (Advanced Life Support) and should limit care delivered to BLS (Basic Life Support).
Good BLS is not bad care.
Good BLS is essential to good ALS.
Not everyone needs a medic.
If your medics are not getting enough practice – assessments and skills performed – then they will get worse.
Simulation is a way to make up for lack of volume of assessment or skills, but requires a lot of medical director involvement to make sure that it is thorough and directed appropriately.
Medical directors need to solicit feedback from the hospitals about the care delivered by the medics. When the medic transports an intubated patient, was the tube properly placed? Was the patient’s airway traumatized by the intubation? Was capnography in place (waveform capnography should allow the printout of this information, but some people are too arrogant to use it)? Was the ventilation rate appropriate? Et cetera.
But, more importantly, was the airway managed appropriately?
If an endotracheal tube was used, was it necessary to intubate this patient?
If a tube was not successfully placed, even though intubation was indicated, was the airway managed appropriately with an alternative airway device, so that the patient was successfully ventilated?
Ventilation is the gold standard, not intubation, and not even oxygenation.
Focusing on oxygenation at the expense of ventilation is bad airway management.
Focusing on ventilation does not exclude oxygenation.
Was treatment appropriate for the condition of the patient?
Did the verbal report match the patient?
If not, why not?
Medical oversight by OLMC (On Line Medical Command) permission requirements is not oversight, but rationing.
Medical oversight by chart review is not oversight but ridiculous optimism that what you are reading is an objective presentation of the patient care delivered.
Medical oversight by the occasional continuing education course is not oversight, but providing continuing education. Continuing education is important and allows the medical director a forum to get to know the medics better, but it is not oversight.
I am negative toward things I see done badly in too many places.
Raising a child is not different.
When my child is behaving inappropriately, I should point this out to my child – unless the “dangerous” behavior has a minor downside. If the consequence is not very significant, then it may be appropriate to allow the child to learn from making the mistake.
This does not apply to patient care.
The downside is not minor.
With airway management, the consequences of bad patient care are significant.
Allowing people to learn from their mistakes does not seem to work well, even with the experience of significant consequences.
Does the criticism mean that I do not love my child?
Not at all.
If that were the case, I would always remain silent and ignore the risky behavior.
I am glad that my child is now a healthy, intelligent adult with good risk management skills and good money management skills.
If only people in EMS, including medical directors, were so easy to teach.
And I haven’t even mentioned bad instruction, evaluation, NR (National Registry of EMTs), bad research, ignoring good research, and a bunch of other stuff in this post. đ
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No. You shouldn’t take that attitude..and I’m very glad, for one, that you don’t.Good analogies in this post…and good luck at affecting a change.What can..patients do to help?
“What can..patients do to help?”It is an excellent question.I wish I had an answer. I spend my time trying to get medical professionals to understand and have not really addressed the role of the public in this.Unfortunately, I think that people automatically look at doctors as experts and assume that they understand EMS. Some do, but even those who have EMS backgrounds may not truly get it.One thing is to look at the focus of the service that provides EMS. Do they focus on the medical care above everything else, or is it farther down the list of priorities?There is not much reason for the highest priority to be anything other than the medical care of emergency patients.
Well, you’ve done it now. You mentioned my name in a positive light over at Street Watch, so I had to come over and see your blog. You are spot on in your observations on medical directors, medical control, and the rest of your post. Without a good, involved medical director, and EMS system is just a ride to the hospital. And a bumpy one at that. You can’t run an EMS system by remote control and expect it to be more than mediocre. If an EMT or paramedic understands the difference between oxygenation and ventilation, they are 90% of the way to being proficient.
Gary,You know there are plenty of people out there who aren’t even 10% of the way to being proficient.Thank you for the positive comments.
Most days I figure I’m about 11% of the way there, so I guess I’m ahead of the game. Gary
seems to me that maybe one thing patients could do is to ensure to the best of their ability that they aren’t patients. Stupid crap has got to be at least one of the top five reasons emergency service is needed in the first place, eh?
Gary,You only get to 11 on the Nigel Tufnel scale. You are well ahead of the game.
Kelly(mom of 6),Avoiding being a patient is a good way to start. Behaving stupidly is one of the ways people encounter EMS, but avoiding stupid behavior should be more about survival than avoiding EMS – even if you are wearing clean underwear.People not acting in their own best interests are not likely to be able to improve their behavior out of consideration for others.