Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Doctor Bledsoe -- Didn't you just expand on the most basic principle of medicine? Primum non nocere. Regardless, I agree and hereby nominate you to the Eddie Chiles Memorial Chair in EMS Skepticism and Crumudgeonry. -Wes Ogilvie, MPA, JD, EMT-B Austin, Texas P.S. -- As for stealing my analogy, I'd advise you to be careful stealing from a thief, I mean attorney. Royalties may, however, be remitted to my Cayman Islands bank account. The List One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Doctor Bledsoe -- Didn't you just expand on the most basic principle of medicine? Primum non nocere. Regardless, I agree and hereby nominate you to the Eddie Chiles Memorial Chair in EMS Skepticism and Crumudgeonry. -Wes Ogilvie, MPA, JD, EMT-B Austin, Texas P.S. -- As for stealing my analogy, I'd advise you to be careful stealing from a thief, I mean attorney. Royalties may, however, be remitted to my Cayman Islands bank account. The List One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Doctor Bledsoe -- Didn't you just expand on the most basic principle of medicine? Primum non nocere. Regardless, I agree and hereby nominate you to the Eddie Chiles Memorial Chair in EMS Skepticism and Crumudgeonry. -Wes Ogilvie, MPA, JD, EMT-B Austin, Texas P.S. -- As for stealing my analogy, I'd advise you to be careful stealing from a thief, I mean attorney. Royalties may, however, be remitted to my Cayman Islands bank account. The List One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 I think they are great. You should probably only need it once or twice in your career. There is a good argument that the simple IO needle at $5.00 a shot is just as effective although it may take 20-30 seconds longer. In how many patients will 20-30 seconds make a difference? I know from my military work that we are having some problems with the sternal IOs. Several soldiers have had to have sternal explorations (ouch!) to remove pins. I know Jeff Salamone, MD has had to explore 2 sternums in Atlanta. VidaCare is a Texas company and we should support it. I just think that IV skills are deteriorating because people are quick to put needles in bones. The one complaint about the EZ-IV I have heard is that many patients need a pressure infusor. I have not seen that in training. I would defer to y or Larry about the reasons. BEB Re: The List Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 I think they are great. You should probably only need it once or twice in your career. There is a good argument that the simple IO needle at $5.00 a shot is just as effective although it may take 20-30 seconds longer. In how many patients will 20-30 seconds make a difference? I know from my military work that we are having some problems with the sternal IOs. Several soldiers have had to have sternal explorations (ouch!) to remove pins. I know Jeff Salamone, MD has had to explore 2 sternums in Atlanta. VidaCare is a Texas company and we should support it. I just think that IV skills are deteriorating because people are quick to put needles in bones. The one complaint about the EZ-IV I have heard is that many patients need a pressure infusor. I have not seen that in training. I would defer to y or Larry about the reasons. BEB Re: The List Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 I think they are great. You should probably only need it once or twice in your career. There is a good argument that the simple IO needle at $5.00 a shot is just as effective although it may take 20-30 seconds longer. In how many patients will 20-30 seconds make a difference? I know from my military work that we are having some problems with the sternal IOs. Several soldiers have had to have sternal explorations (ouch!) to remove pins. I know Jeff Salamone, MD has had to explore 2 sternums in Atlanta. VidaCare is a Texas company and we should support it. I just think that IV skills are deteriorating because people are quick to put needles in bones. The one complaint about the EZ-IV I have heard is that many patients need a pressure infusor. I have not seen that in training. I would defer to y or Larry about the reasons. BEB Re: The List Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 As stated: " Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something " Some of the very best words ever spoken and ones that every medical practitioner MUST adhere to. And one that every instructor teaching EMS must promote. Last year a flight paramedic (he claimed) on this list argued with Gene Gandy about RSI and made the claim that he'd performed RSI hundreds of time. His argument was directed towards instructors teaching RSI without enough experience with it. We should shudder at the thought of a paramedic making that boast. And we have to figure he was most likely lying about " hundreds " but, if he was actually telling the truth, it's frightening and there's a serious lack of medical direction/QI in that man's world. RSI, MFI - whatever you wish to call it - is a great resource when needed but seems to have become one that many, if given the chance to use it, want so much to apply it for their own reasons (so they can say they did) whether or not it's necessary. I think it's about as good an example of a very critical protocol that is not only overused but one that some medics are just chomping at the bit to use. It's one that should require the teaching of the above principle first. Don ************************************************* This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s), please notify the sender and delete this e-mail from your computer. ETMC has implemented secure messaging for certain types of messages. For more information about ETMC's secure messaging system, go to: http://www.etmc.org/mail/. Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Not trying to be critical of ffpmintx@... but when someone states they " love them " (regarding EZIOs) I hope they mean they work well and help to provide a benefit to their patients. We all relate our likes and dislikes of equipment (and that's what ffpmintx' intention is I bet) but when a medic says I use them where I work and " love them " sounds as though they can't wait to use them again. Discretion is the better part of patient care. Don >>> ffpmintx@... 03/02/06 1:03 PM >>> Hey Dr Bledsoe what do you think about the EZIO? We use them in the field were I work and love them. " Bledsoe, DO " wrote: One of the reasons I stay on this list is that it gives me some great insight into the world of Texas EMS and it gives me ideas for some of my writing. I have a contract to do a monthly feature in JEMS as well as a large quarterly article (JEMS Grand Rounds). I am always looking for topics and this list and others are sometimes my muse. With his last post, Wes has helped be crystallize in my mind something I have been struggling with. Thus: 1. What is it in EMS providers that we have to do everything to the max-balls to the wall? We are not happy ventilating a patient with a BVM. Instead we have to intubate them. Better yet, on " good call " we get to cut somebody's neck open. We start an IV on everybody despite the fact that studies show that less than 50% of prehospital IVs are ever used for anything. Now the trend is to put a needle into everybody's bone. We are not happy simply taking somebody to the hospital. We have to " do something " and buy technology we don't really need to " do something " . We are now carrying more people by helicopter who don't really need it because " it is neat " and we can justify it in the name of the mythical Golden Hour or similar horse hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters are all important tools that should be applied only when the benefits outweigh the risks and costs. 2. Some pride themselves on the number of different helicopter pins on their uniform or the number of merit badge course patches which we believe tells others that we are important, save lives, and should be revered. Is it insecurity? What would Freud say? There is a guy I see periodically around the Wal-Mart in Waxahachie. He always is wearing a badge, an EMT shirt, trauma shears and a radio despite the fact he is toting 5 kids to Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and paramedics I ever met were the humblest. I was recently talking with Thom Dick and he reported that he had never called for a helicopter in 30+ years of EMS work. In October of this year, I sat in a hangar in Sydney with about 10 flight paramedics from NSW and the deputy commissioner who is a friend. The purpose of the meeting was to set up protocols to limit helicopter use to certain situations. They were having a doctor call the helicopter for non-critical patients. The people who initiated the meeting were the flight paramedics. They were not going to risk their lives " like the Yanks " by sending their helicopter for non-critical calls. Thus, they put logic and science above ego. 3. We are now buying bigger and bigger ambulances when the smaller ones are cheaper and work as well. Is it just macho or necessary? What would Freud say? 4. We are all deluding ourselves if we say we did not get into EMS for the excitement. We did. Don't deny that. We also all got into EMS because we genuinely like the feeling derived from helping the ill and the infirm. Thus, at what point in our careers (and this is not true for all) did we start doing things for OUR benefit and NOT THE PATIENT. Putting needles into bones, placing patients on helicopters, intubating a child when a BVM will work, immobilizing somebody on a backboard that has less than a 1% chance of a spinal injury, running " precautionary Code 3 " are things we start to do for our ego and no the benefit of patients. I have been in nearly every state in this great union and often heard war stories and people proud of the number of crichs they have done, the number of IOs they have done, or the numbers if chests they have needled. I always want to ask, but never do, is whether the patient got better. Doctors can be as bad as we used to brag about the number of times we had opened a chest. I think it occurs when we come to the realization that EMS is 90% being a good neighbor and 10% being a good technician or practitioner. We write page after page on how to be a good technician and never teach people how to be a good neighbor. Thus, when one become's disillusioned when he or she realizes that all of the crap in Dr. Bledsoe's textbooks are only used for a small percentage of patients, we start playing this mind game. We delude ourselves with the mistaken believe that we are doing " things " to help the patient when, in fact, we may be placing the patient at risk through those actions. 5. Young Attorney Ogilvie is right. We are approaching this all wrong. We should be satisfied by practicing and using the safest and most effective modality before increasing to more complicated modalities. The analogy to police and restraint is a good one and I am sure I will steal it. In our new CCP book, in the airway chapter I authored with Gene Gandy, we used the inverted pyramid to illustrate when airways should be applied. Surgical airways are at the bottom and basic positioning is at the top. That is how it should be. 6. An old Internal Medicine Professor at Texas Tech once told me two things that I follow to this day: 1. Being a good physician (or EMT) is more about knowing when not to do something as opposed to knowing when to do something and 2. Never be the first to use a new drug or procedure nor the last to give up an old one. These teachings are in my mind and probably explain why I write and speak the way I do. Being a good paramedic means that you are first a good human, then a good neighbor, and then a good EMT. Just like 90% of emergency medicine could be handled by a family practitioner, 90% of EMS can be handled with BLS skills. That is NOT saying that emergency physicians with our specialized skills and paramedics with their specialized skills are not needed. They are very much needed for the right patient at the right time. Thant's my story and I'm sticking to it. BEB I entered EMS in 1974 and graduated medical school in 1987. I have NEVER had to do a cricothyrotomy on a real patient and have only used an IO once. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 , While I don't always agree with everything you say, you do however make one good point. Only do what you absolutely must for the patient. Having said that I am not in favor of throwing out the baby with the bath water. Intubation Chest Decompression IO's Cut downs and all of the other invasive skills have their place in EMS and should be used as last resort. I really don't understand all the hub-bubb about intubation. I know lots of rural medics that only get a few intubations a year and have no problems placing a tube. I am on record as stating that you can teach a monkey to tube. I just don't see why it remains so controversial. Henry Bledsoe, DO " wrote: > One of the reasons I stay on this list is that it gives me some great > > insight into the world of Texas EMS and it gives me ideas for some of > my > writing. I have a contract to do a monthly feature in JEMS as well as > a > large quarterly article (JEMS Grand Rounds). I am always looking for > topics > and this list and others are sometimes my muse. > > > > With his last post, Wes has helped be crystallize in my mind something > I > have been struggling with. Thus: > > > > 1. What is it in EMS providers that we have to do everything to > the > max-balls to the wall? We are not happy ventilating a patient with a > BVM. > Instead we have to intubate them. Better yet, on " good call " we get > to cut > somebody's neck open. We start an IV on everybody despite the fact > that > studies show that less than 50% of prehospital IVs are ever used for > anything. Now the trend is to put a needle into everybody's bone. We > are not > happy simply taking somebody to the hospital. We have to " do > something " and > buy technology we don't really need to " do something " . We are now > carrying > more people by helicopter who don't really need it because " it is > neat " and > we can justify it in the name of the mythical Golden Hour or similar > horse > hockey. ET tubes, surgical cricothyrotomies, IO lines, and helicopters > are > all important tools that should be applied only when the benefits > outweigh > the risks and costs. > 2. Some pride themselves on the number of different helicopter > pins on > their uniform or the number of merit badge course patches which we > believe > tells others that we are important, save lives, and should be > revered. Is > it insecurity? What would Freud say? There is a guy I see periodically > > around the Wal-Mart in Waxahachie. He always is wearing a badge, an > EMT > shirt, trauma shears and a radio despite the fact he is toting 5 kids > to > Wal-Mart for Cheerios and Coco-Puffs. Some of the best EMTs and > paramedics I > ever met were the humblest. I was recently talking with Thom Dick and > he > reported that he had never called for a helicopter in 30+ years of EMS > work. > In October of this year, I sat in a hangar in Sydney with about 10 > flight > paramedics from NSW and the deputy commissioner who is a friend. The > purpose > of the meeting was to set up protocols to limit helicopter use to > certain > situations. They were having a doctor call the helicopter for > non-critical > patients. The people who initiated the meeting were the flight > paramedics. > They were not going to risk their lives " like the Yanks " by sending > their > helicopter for non-critical calls. Thus, they put logic and science > above > ego. > 3. We are now buying bigger and bigger ambulances when the > smaller ones > are cheaper and work as well. Is it just macho or necessary? What > would > Freud say? > 4. We are all deluding ourselves if we say we did not get into > EMS for > the excitement. We did. Don't deny that. We also all got into EMS > because > we genuinely like the feeling derived from helping the ill and the > infirm. > Thus, at what point in our careers (and this is not true for all) did > we > start doing things for OUR benefit and NOT THE PATIENT. Putting > needles > into bones, placing patients on helicopters, intubating a child when a > BVM > will work, immobilizing somebody on a backboard that has less than a > 1% > chance of a spinal injury, running " precautionary Code 3 " are things > we > start to do for our ego and no the benefit of patients. I have been in > > nearly every state in this great union and often heard war stories and > > people proud of the number of crichs they have done, the number of IOs > they > have done, or the numbers if chests they have needled. I always want > to ask, > but never do, is whether the patient got better. Doctors can be as bad > as we > used to brag about the number of times we had opened a chest. I think > it > occurs when we come to the realization that EMS is 90% being a good > neighbor > and 10% being a good technician or practitioner. We write page after > page on > how to be a good technician and never teach people how to be a good > neighbor. Thus, when one become's disillusioned when he or she > realizes that > all of the crap in Dr. Bledsoe's textbooks are only used for a small > percentage of patients, we start playing this mind game. We delude > ourselves > with the mistaken believe that we are doing " things " to help the > patient > when, in fact, we may be placing the patient at risk through those > actions. > 5. Young Attorney Ogilvie is right. We are approaching this all > wrong. > We should be satisfied by practicing and using the safest and most > effective > modality before increasing to more complicated modalities. The > analogy to > police and restraint is a good one and I am sure I will steal it. In > our new > CCP book, in the airway chapter I authored with Gene Gandy, we used > the > inverted pyramid to illustrate when airways should be applied. > Surgical > airways are at the bottom and basic positioning is at the top. That is > how > it should be. > 6. An old Internal Medicine Professor at Texas Tech once told me > two > things that I follow to this day: 1. Being a good physician (or EMT) > is > more about knowing when not to do something as opposed to knowing when > to do > something and 2. Never be the first to use a new drug or procedure nor > the > last to give up an old one. These teachings are in my mind and > probably > explain why I write and speak the way I do. > > > > Being a good paramedic means that you are first a good human, then a > good > neighbor, and then a good EMT. Just like 90% of emergency medicine > could be > handled by a family practitioner, 90% of EMS can be handled with BLS > skills. > That is NOT saying that emergency physicians with our specialized > skills and > paramedics with their specialized skills are not needed. They are very > much > needed for the right patient at the right time. > > > > Thant's my story and I'm sticking to it. > > > > BEB > > > > I entered EMS in 1974 and graduated medical school in 1987. I have > NEVER had > to do a cricothyrotomy on a real patient and have only used an IO > once. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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