Re: The List

March 2, 2006

While the email was not directed at me, I'll take offense to the lack of

spell-check and grammar check before posting this in a public forum and to a

respected physician in particular.

One of the reasons that I believe we are not respected by our fellow

healthcare professionals is because so many of us in EMS fail to communicate

clearly, whether by a lack of vocabulary or atrocious written language. Rightly

or

wrongly, no matter how much we excel at prehospital medicine, we will always

be looked upon as the " trained chimps " so long as we fail to present a

professional image. We only have one chance to make a first impression, and a

sloppily written report full of misspellings does not inspire confidence in the

physician reading the report.

While I realize that not everyone has the same level of education that some

of us do, there's no excuse not to improve your language, even if it's just

through reading. Strunk & White's " Elements of Style " is a great place to

find some basic grammatical and stylistic advice. Regardless, reading

voraciously is the sine qua non of methods to obtain a complete, literate

command of

the English language.

Best regards,

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

In a message dated 3/2/2006 4:25:40 PM Central Standard Time,

bentemt2003@... writes:

The below is not intended to offend but if it does I can not change my

opinion.

Dr. B

I take accept ion to the way you generalize EMS providers. I am new in EMS

and take very much pride in the type of care that I give to my Patients and

spend much of my off time reading/studying and practicing my skills. I to

believe that a good Pt. assessment can provide the information that is needed

to

provide the proper care in a given situation. Have I ever started an I.V. that

was not needed or used? no doubt I have. But there has been times I needed a

I.V. very bad I could not get. I have transported a lot of Pt's to

different Er's and most of the time the ER establishes a IV ordered by the ER

doctor. Does that meen that EMS does not need to start the IV or is the

hospitals

starting a bunch of waisted lines under the DR. orders or that a good

paramedic can not distinguish between what is needed and not. I have started

lines

for respiratory distress but ended up not using because I was able to correct

the issue with a BVM or NEB. TX. ect .but i wanted the line just in case.

I routinely pull labs when I establish IV that is really not always needed

by EMS but it speeds up the process at the ER to establish a base line. I do

not question your experience or knowledge as a doctor or your long standing in

EMS but what I question is the perception that a good medic can not

distinguish between what is needed in the field and when it is needed. Is every

medic

practicing good decision making in the field? no I am sure they are not but

that does not meen all of them are not. I have a friend with osteosarcoma

which was diagnosed five years ago as Bursitis without a ex-ray or MRI or any

out of the box thinking because his family had no HX. and it has since mets. to

the lungs. I call a bird when I feel that it is warranted to expedite my Pt.

to the proper facility needed not because they are pretty or neat. After 30

years if he never needed a bird he either lived next door to a good

trauma/medical facility or never had a serious Pt. or sent some to the wrong

facility. Doc I am not a kid at 45 y/o and have seen a few things in my life

to, so I just dont run on excitment along. This is not ment to offend or

challege but to express a few of my opinions which I sure some will change with

experience and time. By the was I did attend your class at conference on pain

management and thought you did a excellent job.

Don Elbert wrote:

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.

[Non-text portions of this message have been removed]

March 2, 2006