Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Would You Know Where to Find an AED If You Need One

There is a contest in Philadelphia to map locations of all of the AEDs (Automated External Defibrillators) in the county –

 

$10,000 prize.

 

Who can map the most AEDs by March 13, 2012?

The MyHeartMap Challenge, which will run until Mar. 13, aims to draw awareness to automatic external defibrillators in the Philadelphia county. Through a scavenger hunt open to the public, the contest offers monetary prizes to groups that can locate the most defibrillators — machines that release electric shocks to the heart to restore normal heart rhythms after cardiac arrest.[1]

Ooh! Ooh! I found one!

Image credit.

“This will be the first AED map in a U.S. city by the public that would be comprehensive for the public,” said Raina Merchant, co-director of MyHeartMap and an Emergency Medicine professor at the Medical School.[1]

The medical school? In Philadelphia? There are Temple, Einstein, Jefferson, Drexel/Hahnemann, PCOM (Philadelphia College of Osteopathic Medicine), and HUP (Hospital of the University of Pennsylvania). As I explain to people, when I am criticizing the almost epidemic lack of understanding of medicine – You can’t swing a Philadelphia lawyer without hitting a medical school, so how do they get away with such ignorance? There is not just one medical school. The people at this medical school may not consider the other medical schools to be real medical schools, but that is nonsense. I searched for Dr. Merchant and found that she is at HUP.

“I ran up to a 50-year-old gentleman who had collapsed on the street and I assessed him, but he didn’t have a pulse,” he said. “A nurse helped me start CPR while I called for a defibrillator,” he added. But in spite of searching a big restaurant and CVS, they could not find an AED right away.[1]

One clue would be to look in places that have a lot of people working there – large office buildings are some of the best places. Nursing homes should have AEDs, but do not expect them to let you use their AED.

“Starting at a local level, making the 911 services aware of where AEDs are is a good first step,” Merchant said.[1]

No. In Pennsylvania all ambulances are required to carry an AED or a manual defibrillator. Why would EMS need to know where an AED is? Did I mention that all ambulances must have at least an AED.

Just because EMS shows up does not mean that EMS will be smart enough to actually provide appropriate treatment. With all of the time we spend training on CPR (CardioPulmonary Resuscitation), we should be able to remember to start compressions and to quickly deliver a shock, but my off-duty experiences with cardiac arrest suggest otherwise.

I dealt with some basic EMT, who insisted that delivering a shock on moist ground is deadly. He was wrong then. He is still wrong. We moved the patient to a backboard made of plastic, which should have satisfied the fool, but he appears to have been more interested in demonstrating that He was in charge, than in patient care. Then the patient was moved to the ambulance and He came up with some other excuse for not shocking the patient. It might have been – I’m not doing anything until the medic shows up! Any basic EMT who ever uses this excuse to not treat a patient should be fired on the spot. This clown was not fired. He was in charge.[2]

Another off-duty cardiac arrest was almost as bad. The only difference is that the patient survived and had a good outcome, even though police and EMS did almost everything they could to avoid delivering a shock to the patient. I may tell about that another time.

I hope that my anecdotal experiences are just a couple of unusually bad cases. I hope that most patients receive better care. At about a year ago, Kelly Grayson and Too Old To Work, Too Young To Retire had a similar call, but they had a much more professional response from EMS in New Jersey.[3]

Footnotes:

[1] Med School scavenger hunt hopes to spread awareness about cardiac arrest
The Daily Pennsylvanian
By David Britto
January 31, 2012, 11:12 pm
Article

[2] Off Duty CPR in the Middle of the Road
Rogue Medic
Mon, 24 Mar 2008
Article

[3] Blogger Save!
A Day in the Life of an Ambulance Driver
Mon, 24 Mar 2008
Article

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Philadelphia – How to Kill EMS

Philadelphia – the city of brotherly love, the city that loves you back, the city that chases you away?

EMS1.com reports that Philadelphia relaxes residency requirements to hire more paramedics.

Since 1953, potential city workers have been barred from taking the civil-service exam unless they have been Philadelphia residents for at least one year.

Why?

Can’t have that city money leaving the city.

Why would people leave if it were a desirable place to live?

That isn’t the kind of question that brings out the city’s famous brotherly love. First half of 2006 – 185 murders, First half of 2007 – 203 murders according to the FBI, with a population of 1 1/2 million. Philly has similar numbers of murders to much larger cities LA – 227 (First half of 2006) and 186 (First half of 2007), pop. almost 4 million. Chicago – 201 and 201 (they get the Emerson award) pop. almost 3 million. NYC – 266 and 235, pop. 8 million plus. Houston – 202 and 172, pop. 2 million. On the other hand, things could be worse – Baltimore – 133 and 155, pop. 3/4 million. Detroit – 210 and 184, pop. almost 900 thousand. This leaves out all of the little cities (pop. less than 100,000) that go out of their way to win the title of murder capital – East Palo Alto, Camden, Chester.

Killadelphia.

So, what would an intelligent person decide?

3 police officers were murdered in 2007.

Seems as if the people who are elected are not in charge.

Pennsylvania 911 dispatch centers had a bunch of changes after the 1994 Eddie Polec murder, so at least that should work well if you believe the puff piece I linked.

Of course, if you call 911 in Philadelphia, you may wonder how things have improved over those dozen plus years.

One night, I called 911 three times for the same incident, a drunk driver asleep at the wheel. The first dispatcher told me to wake up the driver and have him drive away. I refused. Before police could arrive, the driver wokeup when a friend drove by and started yelling at him.

I called 911 back and told them that the apparently drunk driver from the earlier call was moving, where we were, and what direction we were heading. This dispatcher told me that they cannot track other 911 calls and they will have to dispatch this as a separate call.

If you are working in the 911 system, dispatch does not appear to keep track of what you are doing or where you are. If you need help, you might want to make plans other than calling dispatch.

Eventually our hero fell asleep, again. I, being stubborn, called 911 again.

I explained about the earlier 2 calls and was told the same thing about the inability of dispatch to keep track of dispatches. I was told that police would be sent.

About 10 minutes later a police car arrives, but the officer was not dispatched to my location. I explained about the vehicle, still running, and the apparently intoxicated individual behind the wheel.

The officer went to the car tried to remove the keys from the ignition, the driver awoke and tried to drive away, with the officer holding on. The officer removed the keys after being partially dragged for about 50 feet.

A paddy wagon arrived. They were not dispatched either. At no point did any police arrive due to the actions of dispatch.

Good thing I didn’t need help.

“When seconds count, the police are only minutes away,” except when dispatched by Philadelphia 911.

What has changed since 1994?

Bad Call. Some Center City residents wonder why 911 operators don’t know their neighborhood.

Then, just a few months later. New Year’s Day 2008, early AM hours, when nobody expects things to be slow. PFD medic units are significantly understaffed and there is a multiple hour delay in response to a cardiac arrest.

This is Philadelphia, we’ll blame the medic. Here is a forum discussion of the events.

Another death that followed a long delay.

A City Paper story about the state of EMS in Philadelphia.

And another story about the recent problems with EMS staffing.

Philadelphia looks to private ambulance services

The issue came into focus after the early morning death of Deborah Payne, who died Jan. 1 after waiting more than an hour for a city ambulance.

Rob Berkoff of Northeast Community Ambulance noted that he had an ambulance sitting in his shed only seven blocks away while city medic units were overwhelmed by calls from New Year’s Eve revelers.

Defending this position, by bragging about taking an oath to follow orders, is this brain-dead medic. He works for the union, but works against the people who pay for the union.

David Kearney, recording secretary for the city firefighters union and a 15-year paramedic, said city crews are better trained, better screened and better able to handle a range of emergency situations than private ambulances.

“I’ve raised my hand and taken an oath to serve the citizens of Philadelphia and follow orders,” Kearney said. Private companies have different loyalties, he said, and he doubts many crews would be willing to serve all areas of the city as the fire department does.

I would be shocked if even Dr. Deborah Peel would try to take such a position.

Hey, David Kearney, do you have to buy your own knee pads?

Joe Schmider, EMS director for the state health department, said the training and certification requirements for private ambulances and their crews are identical to those for city medic crews.

Here is a link to the PFD medic application information – you don’t even have to interview!

Awesome, dude!

It still lists city residency for 1 year as a requirement to apply.

They have put up bill boards advertising for police recruits – $38,481 per year (same as the medic recruits) and the bad guys murdered 3 police officers last year, wounded some others. Hurry, too good to pass up. If management backs you up the way PFD’s does – even better. Remember to include your $35 application fee.

One of the local papers does a yearly overtime hog piece. Usually at least one medic is in the top five. The yearly articles are designed to shame these horrible city employees for raping the public coffers. What the reporters are only just starting to understand is that these medics are not doing light duty; they are not making a lot of base pay; they are sacrificing their time and health, because the administration is too incompetent to do something about the lack of staffing.

This is not new, fifteen years ago it was a problem. It only seems to have deteriorated.

From the original article:

(Mayor John F. Street) Street saw the change as unfair to those who had demonstrated a commitment to the city by living here. He did not reply to an e-mail yesterday.

He was concerned about the people who live in the city, but not enough to provide competent dispatch or enough people to respond to emergencies.

Fire Commissioner Lloyd Ayers told Council Wednesday that he was skeptical of the benefits of waiving the one-year residency rule to fill paramedic positions. Ayers said that the last time the department did so, a high percentage of nonresidents left for other jobs after completing training.

Hmm. They stay just long enough to realize that anything else is better. Then they leave when they have completed their probationary period, when it would be hard to fire them?

Gosh! They truly are abusing the system. Or they just realize that working for this Fire Chief, in this system (that only looks good in comparison to the District of Columbia), just is not worth the pay – even if you can make over $100,000 with overtime.