If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

21 November 2013

Scenario of the day...part II

The "Scenario of the Day" was presented here. If you did not check it out, go on over.
OK…in looking at what you were presented, it is apparent that the driver struck the deer and veered off of the roadway then overturned. The signs and symptoms presented, along with the vital signs, suggest that the patient is hypothermic, highly probably given the patient’s age and the ambient surroundings. The inside of the vehicle being ‘covered with newspapers’ was an indication that maybe this guy is a newspaper delivery person and this occurred a little while ago and was only recently discovered. Nobody specifically asked, but that was the deal.
Couple of points about the vital signs-

As the body’s core temperature cools the blood pressure drops, the heart rate slows, peripheral pulses fade out, and the respiratory rate slows. If you cannot get a good blood sample, you may get to get the ‘error’ message on the glucometer and you are probably not going to be able to get a good sample. The temperature is a deal clincher, but then the ECG provided the next big clue- Osborn waves, which are prominent as the core temperature goes below 90°F. Blankets are in order- surely more than one. And be wary of exposing the patient- we have to, but remember that the body loses heat by way of convection and radiation. If it is cold outside, put a blanket on the backboard to act as a little bit of a barrier between the patient and the cold backboard. And don’t forget to warm up the ambulance. If you’re comfortable, it ain’t warm enough- turn up the heat.

Even though the SPO2 is only 62%, remember, that peripheral circulation is slowed due to vasoconstriction during hypothermia, which reduces the ability to get a good reading with a pulse oximeter. The lack of cyanosis could be a good clue that the patient is still oxygenating. Given that we lose body heat through respiration, judicious use of oxygen, especially arbitrarily via NRB, should be considered.
Given the patient’s depressed mental status, it is reasonable to go with spinal motion restriction precautions (be alert to potential airway compromise if the patient vomits). There are no apparent extremity injuries, and even though many would consider the blood pressure as ‘low’, it is still above 90 mmHg systolic, so be judicious with the fluids. Also, ‘warmed’ fluids would be appropriate, but be careful not to rewarm the patient too fast. Don't have an IV fluid warmer? There are some ways to accomplish that, but...you're not trying to rewarm them, just stave off the continued drop.

With the fast extrication he obviously was not pinned. There were no obvious injuries, however, just due to the GCS and his age in the setting of a potential traumatic event, he meets Trauma Notification Criteria per CDC guidelines. However, that does not necessarily indicate flying him out. With the short drive time, it will be doubtful if there is any true time savings going by air. If you're not going to save any clinically significant time, why bother. I know, helicopters are sexy.
Cancel the bird.
But what if the helicopter lands? Well, if the patient needs it, and the helicopter is going to save a significant amount of time, the put them on it. But, when you figure in the turnover time, the loading time, the take-off and flight time, along with the off-loading time and going into the hospital, you are not saving anything over a 20 minute ground transport time. This guy is fine to go by ground.


20 November 2013

How well do YOU take care of people?

Not long ago a friend of mine relayed his experience with EMS in another county during a family emergency. That chat reminded me of an experience my parents had with EMS several years ago.
A while back over on The Happy Medic, San Francisco Fire Department Paramedic Justin Schorr wrote about his family’s experience with a child’s medical emergency. And of course, Justin zeroes in on some EMS related issues. Be sure and go over to read his blog. Good stuff, it is.

But anyways, once again, it kind of got me to thinking. How well do we really take care of people?

It depends upon what you think it involves. Of course, we have protocols to follow, skills to do, and on and on and on. But there are other things that we need to do that are just as important. And they have nothing to do with starting an IV, reading a 12-lead, or any of that other stuff you learned (hopefully) in paramedic (or EMT) school. It’s all about how you take care of people.

Justin mentioned something in his blog about warming a stethoscope. So just how many times do you take the time to warm up a stethoscope before you place it on a patient? Especially in the winter time when it has been hanging in the back of an ambulance, probably on that catch-all-netting at the head of the bench. Even when it is wrapped around your neck it gets cold. Little kids and elderly patients are kind of sensitive to that cold stethoscope. And guess who makes up a large number of our patients? Yep, you got it. So take a few seconds, tuck the bell under your arm. Probably would be a good thing to do when you are introducing yourself to your patient. You do introduce yourself to your patient, don’t you?

Another thing I have noticed is that the entrance to Walmart is smoother than the entrance to most of this area’s Emergency Departments. So, do you take it easy over those entrances, or just bump on across? Based upon what I have seen, most of us just bump on across. Probably feels really good with that broken hip, bone cancer, or any one of many maladies that hurt when you move. 

And when entering the ambulance entrance to several of the area EDs, it seems that the worse part of the trip is when you are turning into the ED. And we know doubt know it since we do it enough. So how many of you just turn on in, bumping and swaying? And how many of you think about your patient (and partner) in the back of the specialty vehicle you are driving that is NOT known for its smooth ride? If you are the one that just drives on in without consideration for your passengers, I bet you are the one that does not slow down and ease across railroad tracks as well.

But what about other things along the lines of ‘taking care of people’?

Do you explain what you are going to do and why you are going to do it? As I get older I am exposed to the healthcare system just a little bit more. At my colonoscopy I saw a wide variety of ‘explaining’ and the lack thereof. The nurse that started my IV had a good technique (well, her tourniquet technique sucked) but she barked out orders like a drill sergeant- “Put your arm down”, “Make a fist”, “Hold still”. And when she was done she just walked away. Oh yeah, and there was that introduction- “I’m gonna start your IV”.

Well, she did tell me what she was going to do. And what do to. In no uncertain terms. But ‘why’ would have been nice. So would a personality.

I always tell my patient (even if they are unconscious) what I am going to do, why I am doing it, if it’s going to hurt, etc. And you should too. It is part of the reassuring process. For a lot of people (I like to think most of them) the whole process of getting hurt or sick and calling 9-1-1 is a pretty stressful and frightening event. A big part of our job is reassuring them and alleviating their fears. And to do that you must tell them what you are doing, why you are doing it, and quite frankly, if something is going to hurt. Before we do it.

And how well do you ‘relate’ to your patient? You know, that rapport that you have to establish early on to gain their confidence. I have seen some people that are really good at it, while others…well, some people are really good at it. It’s all of the stuff above, and a little more. In my old system we used Panasonic TOUGHBOOK laptops to complete our call reports. And there was a natural tendency to type as you rode. And that is OK if you can pull it off. By 'pull it off' I mean that you have to maintain that rapport, that relationship, with the patient. And that means you have to talk to them. Pay attention to them. And, egads, reassess them.

Reassess means more than let the Zoll's blood pressure monitor recycle every few minutes and take a look at the pulse oximeter reading every few minutes or so. It means talking to them. It means asking them if they feel better, if the oxygen is helping them or if the pain medication is working. Or if they’re feeling worse. And you CAN’T sit in the ‘captain seat’ and do that. And sitting in that captain seat, typing away, and asking your patient, from behind them, without making eye contact, if they are OK, to me, is worse. I know someone who did that and arrived at the ED with a deceased patient...who was not deceased when they put them in the back of the ambulance.

Taking care of people is a total package. Sure, starting that IV and reading that 12-lead is important. But being nice (because nice matters) is just as important. Maybe more so. In the end, it is the total package that matters. It is the total ‘A’ game.

And you have to bring that total ‘A’ game to every call, every time.

Anything less is not doing your patients (or their families) any favors.

19 November 2013

Scenario of the day...(UPDATED)

You are dispatched for an MVC at 06:33. The location is on a rural road approximately six miles from your station. A fire officer arrives, establishes command, and tells you that you have an elderly male, unresponsive, and entrapped in the vehicle. Command notifies the dispatch center to “put a bird in the air”.
You arrive to find an approximate 65 year old male in the driver seat.  Damage is as noted in the picture. There is no passenger compartment intrusion and the patient appears to have his seat belt on. The inside of the vehicle is covered with newspapers (dozens and dozens of them) and many more are on the ground around the vehicle.
First look at the patient- GCS 1-1-1, RR 12 shallow and snoring, pale looking skin.

There is a large, dead deer lying along the roadway near the crash.

It is early morning, the sun is rising, it is cloudy, 34° F, 54% humidity, and the wind is at 15 mph out of the SW. Traffic is light. You have an EMT for a partner. You have a QRV-based supervisor within 15 minutes; your next nearest ambulance is 20+ minutes away.
What are you going to do?


The first vital signs after you get in the vehicle-

BP 94/58
HR 40 weak and irregular
RR 10 shallow and snoring
Pupils equal and reactive
Finger stick gets an ‘error’ reading
Tympanic temperature 84°F
SPO2 is 62%
Skin is pale and dry without cyanosis

The first ECG-
courtesy of Dr. Smith's ECG Blog
 Ground travel time to Level I trauma center is 15-18 minutes. Travel time to community hospital is 15-20 minutes.
The fire department has the patient free within 10 minutes. The helicopter is “five minutes out”.
Patient is exposed- no obvious deformities to any extremities. Chest expansion is equal bilaterally and lung sounds, while faint, seem to be clear. Carotids are faint- radials and pedals are absent. Upon extrication patient GCS is rated at 3-4-5.
You find three pill bottles in the vehicle (you DO take a quick look for such things, don't you?)- levothyroxine sodium, morphine sulfate, and paroxetine hydrochloride.
I have one response so far (Thanks, Cathy!). C'mon folks...
What do you think? What special things (if any) are you going to do? Is there anything different that you might do? Let's hear it.
Note: If you need a bigger copy of the ECG, email me at the address to the right.

08 September 2013

How long does it really take?

Dispatched for a motor vehicle crash (MVC), Upon arrival there is a patient who was riding an ATV and was struck. The patient was ejected and then part of the ATV landed on him. There are obvious patient care issues and such, but which mode of transport do you use? Air or ground?
Some things to consider-
1. You have a Level I trauma center 30 minutes driving time away (it could take longer- that depends upon traffic conditions).
2. It is clear weather.
3. Your patient meets CDC Trauma Notification criteria.

Should you fly the patient? After all, flying is quicker. Isn’t it?

Well…maybe not. There are a few things to consider.
First, how long before the helicopter gets to you, assuming that it was not requested until you arrived. If it was ‘placed on standby’ while you were en route, how long before it gets to you? Figure five minutes to get into the air (based on what I have seen while watching helicopters take off) and then whatever the flight time to your location is. Then there is the landing and the crew exiting the aircraft. And no, it is not like any DUSTOFF mission you have ever seen where the flight medics and/or crew chief jump from the aircraft and run to the medics.

Second, how long does it take to provide a patient report to the flight crew? My experience? Five to six minutes. What I have seen documented? Anything from five to twenty-four minutes (yes, you read that right).
Third, they have to load the patient onto the helicopter. Again, this is not like Vietnam or Afghanistan where they open the doors and the patient is rapidly placed into the aircraft. No, this is a process. I have never seen it done in less than five minutes. Maybe it can be done quicker, but sometimes it takes longer.

Then there is take-off and flight time and landing. Then the patient is unloaded and taken into the facility. At two of my local facilities, this is five minutes or so. And no, they are not running.
So how long did that flight actually take? Figuring in best case scenarios of five minutes for each phase listed above, and allowing for a twelve minute flight time, then we have taken about 27 minutes from the time of patient report to unloading the patient at the facility.

For a 30 minute trip, we have taken just under 30 minutes. In ideal conditions, we have shaved three minutes (maybe) from the transport time.
But, what if you have to take the patient to the landing zone? Depending on where that is located, we are talking maybe five minutes. Or more.

Based upon some research on call records I discovered the following intervals. Documented.
1. Travel to landing zone- 5-9 minutes.
2. Patient turnover to flight crew- 5-24 minutes (out of several flights, only one was 24 minutes; one was 18 minutes, the rest in the 5-9 minute range)
3. Loading the patient onto the aircraft- 5-9 minutes
4. Figure a flight time of 10-15 minutes.

Then, when you figure in timed observations at a couple of the local facilities for unloading the aircraft and taking the patient into the facility of 5-8 minutes, that short flight to the trauma center actually can take takes 30-50 minutes. Yes, you read that right.
At best, that 30 minute drive turns into a 30 minute flight.

So we have saved…what?
Now, don’t take this to mean I am totally against medical helicopters. I am not. I think they are a fantastic resource in certain circumstances. I also think it is pretty neat flying on a helicopter. And I think they just look cool.

But, I also think I have to do what is best for my patient. All the time. And if I can get the patient to the trauma (or STEMI or stroke) center in a reasonable time by ground, then I need to hit the highway.
Helicopters can save time in certain circumstances. If the landing zone is close by, and the helicopter is waiting for you when the patient is extricated, and the driving time to the facility is extended (40-45 minutes or greater, then maybe there is an advantage to cutting 5-10 minutes off of the time it takes to get the patient to the hospital.
A lot of the research says otherwise, but I know how some people feel about the research.
The 'romance', if you will, with medical helicopters grew out of the 60s. Many people have a memory of news video from the Vietnam war of Army UH-1's with red crosses emblazoned front and sides, landing ever so briefly in a rice paddy for the wounded, then hustling them off to army MASH units.
We became enamored with flashy terms like "The Golden Hour" and ""The Platinum Ten Minutes". But where was the research into those time frames? Sure, it is intuitive that a trauma patient gets to a trauma center quickly, but how quickly?
You can search the internet now and find videos of DUSTOFF missions from Afghanistan where UH60s swoop in, and after just a minute or two on the ground, hustle their wounded cargo off to field hospitals, bypassing the less-than-developed road system, laden with IEDs, that is Afghanistan.
But that is a different world than what we live and work in.

07 August 2013

Homes and Stability

For the record, I have never been homeless. On the other hand, a couple of times I have been close. Such are the times we live in. You can make the right decisions, or at least not the wrong ones, or even big wrong ones, and things, well, implode.

A lot of attention is thrown towards homeless veterans. There are a lot of reasons why it turns out that way, and deep down, there is a part of me that truly believes that no one really wants things to turn out that they are homeless. With nowhere to go.

In reading the comments, there are a few people that think this is a bad idea. I guess it is part of that ‘give a man a fish and he eats for a day, teach him to fish and he eats from now on’, or something like that.

Of course, in my travels on an ambulance, I have seen my share of homeless people. And for the most part, they are basically good people that either life through a curve ball, or maybe they did not make the right decision(s). Sometimes, it can be about not being taught what the right decisions are.

My hometown has a large homeless shelter on the south side, and there are a couple of other places for folks to go. But of course, those are not intended to be long term solutions. And somehow, I don’t think this is a long term solution, but it is a start.

Things are a lot easier if you know you have a place to go, a place to eat, a place to sleep, bath, and keep your stuff. Maybe it is the difference in getting back onto your feet and making a difference.

And some people will say this is another form of socialism, of hand outs, or pandering.

To you I have one thing to say…maybe.

But, these folks have demonstrated that they can work, that with a little, well, supervision and stability, they can contribute.
And in my mind, anyone that rose their right hand to swear an oath to defend the constitution of the United States, against all enemies, both foreign and domestic, then well, they have earned that extra helping hand, whether it is healthcare or help getting a place to stay, or priority points in getting a job.


23 July 2013


There is a lot of debate these days on the concept of “community paramedics”. Me personally, I like the concept. I see too often that our current way of doing things (I am not trying to start a philosophical debate on the status of our healthcare system and the desires of some to turn it into, as one writer calls it, “government run cradle-to-grave healthcare”). As an EMS provider for my entire adult life, I have seen the gaps in the care that people receive (I do, however, believe in cradle to grave healthcare, no matter who provides it.) when they are sick or injured. There are rules that have to be negotiated, minefields of insurance and healthcare bureaucracy that stand poised to ‘regulate costs” and determine eligibility.

No matter, people have needs. When those needs are not met, guess who they call? And like it or not, there are a lot of EMS folks out there who get a little bummed out when they have to transport the same person, over and over, for maintenance of that patient’s ongoing and/or chronic condition that is not being managed or met.

Is being a community paramedic for everyone? Of course not. The same reason that every paramedic is not suited to be a firefighter and every firefighter is not suited to be a paramedic (opinions of the IAFF and others not withstanding).

But it is a need that someone needs to fill. So why not us?

Over at the blog Rescuing Providence the author writes is top ten reasons he does not like community paramedics, and you can go see that list here.

Of course, there is a really good response over at Captains Chair Confessions where he addresses each of RP’s ’Top Ten Reasons’.

And then, there is this jewel over at Too Old To Work, Too Young To Retire, where Too Old throws in his $0.05 worth and he does make some good points.

So why am I a proponent of the community practice concept? Yes, a lot of these areas are supposedly covered by nurses. And I know that EMS is typically ‘fee for transport’ funded. But I do believe we have to get away from that, and that we do need to take a page form the fire service playbook- public outreach.

In my mind the idea of the community paramedic is to ‘fill gaps’.

Like Too Old, my parents have had experiences with the healthcare system and the home health care field- or lack thereof. My father never got home health care, even though he was incapacitated. Instead, it was left to my mother to care for him, with a little help from me, my wife, and my daughters. I don’t know that EMS could fill that role in the area of community paramedicine, but where I do see opportunities is public education.

I have seen patients who are discharged from the hospital for whatever condition and by the time home health care is set up for them they have already been transported twice to the ED. Is it because they are irresponsible? Sometimes. But more often than not, in my experience, it is because the doctors and nurses explained everything at a college level to someone who may not have finished high school. And nobody explained to them that the Good Old Boy Rule* did not apply to drugs like atenolol, furosemide, or amlodipine.

Recently my mother was given a medication for her COPD that she did not understand how to use. Coupled with her eyesight and arthritis, that did not turn out to well. And she is not alone. Many times people simply do not understand how to manipulate the medications or devices. And please, do not tell them to ‘check out a video on the internet’. Most of these people are like my mother and do not have internet, or even a computer.

I have seen opinion pieces about the plight of poor people and others about how they are responsible for it. Maybe. But guess who gets to take care of the aftermath?

Maybe it is a failing of our public education system, a failing of our evolving values as a society…whatever. The fact is, we have to change the way we do business. You call we haul is not sustainable.

There are other parts of the RP Top Ten that I wondered about, but then, I am not familiar with what everyone else is doing. But my own idea of what a Community Practice Paramedic program in my little slice of rural America would look something like this-

  1. Follow up on discharges from our local hospitals for patients who have respiratory diseases, heart disease, and diabetes. No we haven’t been trained in it, but there are a lot of things I have learned in the past few years. And the reason I/we cannot learn a little more is….what? I’m not so much concerned about insulin pumps, but the person who just got discharged after treatment for severe COPD or CHF and they do not understand all of the gobbledygook that the doctor or discharge nurse threw at them in rapid succession.
  2. Fall prevention. The model is based on what the fire service has been pretty successful at- fire prevention. Imagine EMS getting dispatched to the same residence twice or three times in a week or two for a fall at the same residence. No transport, so no fee. Why not send someone in to check with the residents and see if we can help them minimize their fall hazards? Maybe they did not know about how throw rugs and all of those nick-nacks are causing the problem. Maybe they just need some ideas. Maybe the other family members might get involved?
  3. Referrals. In my career I have been to many EMS calls for people who need a doctor but don’t know who to call.
  4. Mental health referrals. I am not talking about counseling. I am talking about calls that I have gone to where a medically stable person wants some help. Maybe it is with alcohol, drugs, or just…life. Maybe they did not need an ED, but there are other options out there. In my area, we have crisis counseling that can come to you.
  5. Alternate destinations. My old employer started a community paramedic program of sorts, and one thing we did was if a person just needed a place to stay, or maybe a detox, we had options other than the ED. It sort of ties in with #4.

Is a community practice paramedic program for everyone? Maybe not. But it is another option that we need to really look at. And no, not everyone is cut out to be a community paramedic. Just like all of those paramedics that are not cut out to do high angle rescue, firefighting, confined space rescue, etc. And just like all of those people who do high angle rescue, confined space rescue, water rescue, trench rescue, and firefighting who are not cut out to be a paramedic.
*- Good Old Boy Rule- If a little bit is good, then a whole lot is better.

16 July 2013

Scene safe, PPE...NOT!

We’ve all heard it for years. The first thing we do and say when we are testing or going through a scenario for any EMS class is raise our hands and recite “Scene safe, PPE”. We’ve fooled ourselves into thinking we work in a ‘safe environment’. We’ve fooled ourselves into believing that maybe the presence of a law enforcement officer will provide a ‘safe environment’. We’ve fooled ourselves into thinking that since we are the ‘good guys’ no one is going to try and hurt us.

Guess what? We were wrong.

It is getting to be a common occurrence to read about another incident that has happened somewhere in our country where a member of an EMS crew has been attacked or assaulted, either with a knife, a firearm, or just a physical attack. Here are two links that I have seen in the past few days-


And over at EMS1.com, author Steve Whitehead has a pretty good take on the whole thing of "scene safe, PPE". I like his idea of teaching risk assessment and management. Like he says, it is not enough to 'acknowledge' that many of our scenes are not safe- we have to prepare for it. We have to realize that just because the scene was safe in the first 10 seconds, that does not mean it is safe in thsecond, third, or fourth 10 seconds.

It reminds me of something Sergeant First Class Bruce Grimes once said to me and the other members of my basic training platoon- "Stay alert and stay alive".

But anyway, in getting into the debate about unsafe scenes and assaults on EMS, the first thing someone is going to say is “let’s arm EMS”. The biggest flaw with that idea is that who is going to pay for the training necessary to be familiar with a firearm, let alone proficient with that same firearm? And then who is going to pay for the firearms? I can go on, but let’s just say that there are a bunch of hurdles to that one. Plus, I have worked with a lot of people that I really don’t trust with a firearm.

There are various courses out there that seek to educate and prepare EMS folks in how to evade or escape these encounters as well as how to defend themselves when escape or evasion is not an option. DT4EMS comes to mind.

But then, who pays for these classes?

I don’t know about some of the other states, but in my home state we are required to get 24 hours of continuing education each year of a four year cycle, with mandatory requirements in certain categories. There’s not a whole lot of leeway within the requirements, unless hours are added for something like DT4EMS.

So what are we to do?

First, we have to get out of the mindset that we work in a safe environment. We don’t and we never have. Think otherwise? Ask those five firefighters in Gwinett County, GA. Ask the EMS crew in Omaha or the EMT in Jersey City, NJ. Hell, you can ask one of my coworkers here with my current employer.

Every single scene we are on has the potential, the very real potential, to go very badly very quickly. And quite frankly, many of the folks I have worked with over the years are woefully unprepared to deal with it.

Second, we have to provide training and education to our people in how to deal with these situations. Simply saying “well, maybe it can happen to us” is not enough. We’ve got to prepare. I’ve done some research on the course and I like the concept of DT4EMS. I think it (or something like it) should be mandatory for every EMS responder in the country. It should be a part of the national curriculum, every state curriculum, and the National Registry requirements. Period. If it takes extra time, then so be it.

It has to be geared to our environment. I am not talking about martial arts training or some modified version of law enforcement or corrections training. What we have to have is some sort of training that is geared to us and to our environment. But is that all there is to it? Is taking a course that prepares us to evade a hostile encounter or defend ourselves really enough?

Well, no, it is not.

Thirdly, we have to develop plans, procedures, and protocols that cover how we deal with these situations. We have to have the equivalent of the fire service’s “MAYDAY” or law enforcement’s “SIGNAL 25” (maybe we can use one of their terms, but it has to be one or the other- I prefer MAYDAY since, well, I just do.).

And we have to train with it. More than “once in a while”.

We also have to change the way we train and re-train.

Sure, wear your gloves. Use your PPE. But don’t assume you are working in a safe environment. You’re not.

05 April 2013

The View From Under The Bus

Over on Facebook, on the page Paramedics on Facebook, there is an entry by an old boss of mine, Chief Skip Kirkwood. Now, there are a few things that Chief Kirkwood and I disagree on, but there are a few we agree wholeheartedly on. And this is one of them.

Chief Kirkwood asks the question, basically, why do we in EMS suffer from a lack of camaraderie, brotherhood/sisterhood, sense of family, or whatever you want to call it?

Basically, it is this- Why do we as EMS providers seem to be so willing to throw our co-workers under the buss at the drop of a hat?

I’ve seen it. Someone makes a mistake or a call goes bad and the crap starts flying. I’ve seen careers and reputations hurt by it. Really good people suffering long term at the hands of other, for all practical purposes, good people. Why?

I wish I knew.

When I was serving in the United States Army, we had folks that struggled. Maybe they were not too good with push-ups, they couldn’t hit the broad side of a barn at two feet with an M-16, they had trouble starting IVs, or just had some problem with some task or another. Did we throw them under the bus? Did we initiate a blanket party as depicted in “Full Metal Jacket”?

No. Not just ‘no’, but ‘heck no’. We helped them. During my Army career I can remember running in the rain, doing push-ups in the rain, letting fellow medics practice IVs on my arms, studying flash cards of obscure military facts, along with dozens of my fellow soldiers and NCOs…whatever it took to help my fellow soldiers overcome their obstacles.

And guess what? Never once did we fail.

During my fire service career, we had folks who had a hard time pulling attack lines, getting into an SCBA in less than five minutes, crawling around in turn-outs and SCBA, trouble with friction loss calculations, setting up and climbing ladders…you name it. And me and my fellow firefighters did what needed to be done- we helped them out. To use the quote from “Apollo 13”- failure was not an option.

I see this phenomenon in military and fire service all of the time- people helping people. In the Army, we did not throw people under the bus. In the fire service, we did not throw people under the bus, either.

But EMS? You make a mistake, a call goes bad, or a call goes like you think it should not have gone, and word travels faster than you can say “uh oh”.

Now don’t misunderstand me. The military and fire service are full of Monday-morning-quarterbacks who will second guess what other people do. All you have to do is look on the internet at any one of the thousands of blogs and forums out there. But it is always ‘someone else’. It is not the co-workers or fellow soldiers/Marines/sailors/airmen of the person who slipped up or had a bad moment.

EMS people? For whatever reason we will cast you to the wolves. Handle a call in a way that goes south? What your chain-of-command does to you is nothing compared to what your co-workers will do. And what is worse is something that I have seen in EMS that is, well, unique- command staff members that will throw someone under the bus, as well. Those are the ones that will tell their subordinates about the trials and tribulations of a fellow subordinate.

So what is it about EMS that grows this behavior?