Divemedic

If you remember, I posted a few months back about a push to have a referendum on the ballot for voters to approve a law that would require Orange County employers offer sick leave to their employees. The law would require that an employer give employees one hour off with pay for each 37 hours the employee works. This will increase labor costs by at least three percent.

Of course, there were lawsuits. Unfortunately for the socialists, they sued the wrong person. By the time they got around to suing the correct one, it was too late to stop the ballots, which were already being printed.

The thinking astounds me. The proponents of the law say that “it’s wrong for employees to be punished financially if they’re too ill to come into work.” but see no problem with punishing a business financially if the employee doesn’t work.

Looks like the “Captain of a Crew of One” has had a bit of a mutiny, unless we are to believe that he has posted 46 posts today about cutting hair…

A firefighter is forced to resign for writing a Facebook post after a call where a
2-year-old was hit by a car, allegedly stating that the child was
unattended and asking where the mother was.

How many times have we all
wondered the same thing? It’s a shame that a man has lost his job, and
three others are facing discipline, while the irresponsible parent gets
nothing for allowing this child to be out on the street to be injured.

Public safety agencies are so worried about this politically correct attitude, so afraid of ruffling feathers, that they  would rather hang employees out to dry than ask why a 2 year old was on the street unsupervised.

Yet another reason why I retired. 

Medic Protip of the day: Sepsis in an infant causes intravascular volume
depletion via increased capillary permeability and vasodilation. This is a form of distributive shock. The therapy of choice for pediatric patients with sepsis (as evidenced by tachycardia and increased capillary refill time in a febrile patient) is bolus doses of isotonic crystalloid or colloid fluids. This should be done until perfusion improves, or new onset rales develops. Dose is 10-20 ml/kg, titrated to heart rate, capillary refill, urinary output, and changes in level of consciousness.

So I sat through a class this week that has been given to all military personnel for the past through years, called Tactical Combat Casualty Care (TCCC). The course was being taken by a variety of students, including two cops, five paramedics, two paramedic students, six firemedics, and a prepper.

The instructor introduces the course, and says how topical and important it is, because of spree shooters, and how they present a great risk to rescuers. He then mentions that the recent shooting in New York, and holds it up as an example of why the course is so important.

So I pointed out to him that 10 of the 11 people shot in the incident were shot by the responders. He argued with me and told me how wrong I was, until another student backed me up. His comment at that point was “Oh well, casualties of war.”

That is the mentality that is present in the police force, summed up in one conversation.

One of the struggles that I have as an EMS educator and as a practitioner is laziness. That is, too many people in the medical field want to take the easy way out. They want to do the minimum that will not get them fired or sued, and then move on to the next task.

I have seen incompetent doctors, paramedics, nurses, and other supposed professionals do what is in their own best interest, and not what is in the patient’s best interest. In many cases, that means blindly following some algorithm or procedure, without applying even the smallest bit of thought to what is actually going on with the patient.

As an educator, I even see this all of the time. Paramedic students who are being asked to learn the underlying physiology and mechanisms of a patient, to better treat and help that patient, frequently complain that the class is too hard. They just want to learn protocol. They want to practice cookbook medicine.

I teach paramedic classes at a two year, private college. As a part of ongoing QI, the school looks at a list of data. They look at the passing rates of graduates taking state board exams, the completion rates of the students taking the courses, and they also do a quarterly opinion poll where the students get to rate the instructors. There are four instructors who work in the paramedic education department.

In this poll, the students complained that two of the instructors simply read the power points to them. I always hated that as a student, and I have always tried to avoid that. I really believe that the instructors who teach that way are doing so because they are not familiar with the material.

The complaints in the poll about my class were that it was too difficult, that they only want to learn: “if you see symptom A, give drug Y” and not have to learn anything about the underlying processes. I was told by the department head that I have to “dumb down” my classes, so that the poll numbers look better. It looks like I will have to teach cookbook medicine from now on.

I am ready to go back to the clinical environment. I have been teaching for eight years, and retired from paramedicine for 9 months. I am ready to get out of academia.I don’t want to create technicians, I want to create professionals. It looks like I am trying to deliver a product that no one wants.

2003

Three minutes after the initial call to 911, we arrived at
the front of a small, well-kept house, a typical one for the area. There
are toys scattered about the yard, undoubtedly left there by a small
child.

The first through the door, I arrive in a rush and take in
the scene. Even now, nine years later, that image is burned into my
memory as clearly as if it were yesterday. There is a small child lying
on the couch in the living room, a small pitiful figure, his skin is a
mottled gray. He is covered in water and appears lifeless.

An
adult male is standing next to the couch. He is soaked from the waist
down, his clothing disheveled; his eyes red-rimmed, he looks like a wild
man. I will not find out that this man was the child’s uncle for
another fifteen minutes.

I pick up the child, and he is cold. He
does not stir, even when I harshly pinch his arm. I move to the door, to
the safety and privacy of the truck.

On the way out to my
ambulance, I quickly look him over. He is about three years old, 12
kilos or so. Lying lifeless in my arms, he doesn’t appear to be doing
very well. He isn’t breathing and has no pulse. My mind already
computing drug dosages and accessing protocols, I reach for my radio and
called in a “code” to the dispatch center.

I place my lips over the child’s mouth, and give gentle breaths. Chest compressions. Breaths.

We
arrive at the truck, and I select the proper sized ET tube, and slide
it down his throat. My partner begins squeezing the bag, and I start an
IV.

I place him on the monitor, and I note that he is in asystole. Not good.

I spent the next 40 minutes fighting the battle that I knew we had lost before we even arrived.

As
the helicopter flew away, taking with it the small, pitiful body once
so full of life, so precious to all who knew him, his Uncle approached
and asked me what he should tell his brother. He wanted to know how to
tell a man that his baby boy drowned in a backyard pool while his Uncle
took a shower. He then put his head on my shoulder, wrapped his arms around me and cried for the next ten minutes.

I went back to the station, numb. I didn’t know what to feel. All I knew was that I was empty, spent. In the weeks that followed, I had a harder and harder time going to work and functioning. I finally told my supervisor, they referred me to CISM. I was in therapy for that call for a while. It was hard to deal with. I even took anti-depressant medication for about 6 months. It was tough living with the ghosts of that call. I still get teary eyed sometimes when I think about that day, about what I could have done differently. Normal reactions, I think, to such a tragedy.

There are those who would deny me the right to own a firearm because I feel pain at the loss of a child. They wish to see people lost their rights without a hearing or a trial, simply because I sought help when I needed it. Millions of Americans seek therapy, or take anti-depressants, and own firearms. None of them killed anyone yesterday.