Boston EMS TV Show

[Chewy20]

Immobilization and positioning goes a long way for controlling pain. I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control. Pain control does not equal meds all the time. Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival. Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.

Don't bother reasoning with him. Not worth your time. I learned the hard way.

 

[RocketMedic]

Jam it, Chewy20, your "reasoning" is mindless adherence to whatever you think trendy.

It's good to know you consider things on a case-by-case basis, medicsb. Your original post came off as disturbingly absolute. Personally, judging by the source material, there looked to be a decent amount of post-immobilization distress.

I'd love to be able to perform reductions in the field, but to get to that point, I think most systems need to work towards much higher standards of education.

 

[triemal04]

Immobilization and positioning goes a long way for controlling pain. I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control. Pain control does not equal meds all the time. Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival. Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.

Burn the witch collaborator! Burn the witch collaborator!

See? Knew that was going to happen; standard procedure really. As was mentioned, don't waste your time with him. Especially when it's someone who took joy in a paramedics suicide.

 

[jwk]

I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...

Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.

Oh puhleeeeeeeze....seriously?

Not every patient needs drugs, particularly narcotics. They are NOT the solution to everything. And the measure of a good paramedic is NOT determined by how much "analgesia" they give.

 

[Carlos Danger]

I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...

Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.

PTSD and refusal of payment because you didn't get narc'd up for a patellar reduction? Seriously?

Look, just stop. Really. You are embarrassing yourself and you don't even know enough to realize it.

#doingwhattheEDdoesbutat70mph

Immobilization and positioning goes a long way for controlling pain. I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control. Pain control does not equal meds all the time. Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival. Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.

Pfft. Srsly doc? What do you know? You'd give 100mg of ketamine before doing a patellar reduction if you had any clue what you were doing!

And positioning? That silliness is for EMT's - just like mask ventilation. I'm a freakin' PARAMEDIC, dammit! I gots fentanyl and ET tubes!

Oh puhleeeeeeeze....seriously?

Not every patient needs drugs, particularly narcotics. They are NOT the solution to everything. And the measure of a good paramedic is NOT determined by how much "analgesia" they give.

Oh yes_they_are.

Don't you know that the amount of drugs that you give absolutely defines how good of a medic you are? You ain't crap if you don't dope everyone up on as much ketamine and fentanyl and possible.

Cuz the ED docs don't know what they are doing. Or something like that.

 

[Fleury14]

It also must be taken into account that given Boston's relatively small size, that transport was at MOST ten minutes and it was more likely around 5.

 

[NTXFF]

Coming from a system that's able to do reductions I'd feel like too big of an anus to not give them at least a bump of some love juice before I get going.... But that's just my two cents.

 

[NYBLS]

Oh puhleeeeeeeze....seriously?

Not every patient needs drugs, particularly narcotics. They are NOT the solution to everything. And the measure of a good paramedic is NOT determined by how much "analgesia" they give.

Correct, but managing a pts pain is important and should no be ignored. I think properly managing a pts pain is a good indicator for a good provider (among many other things).

PTSD and refusal of payment because you didn't get narc'd up for a patellar reduction? Seriously?

Look, just stop. Really. You are embarrassing yourself and you don't even know enough to realize it.

#doingwhattheEDdoesbutat70mph



Pfft. Srsly doc? What do you know? You'd give 100mg of ketamine before doing a patellar reduction if you had any clue what you were doing!

And positioning? That silliness is for EMT's - just like mask ventilation. I'm a freakin' PARAMEDIC, dammit! I gots fentanyl and ET tubes!



Oh yes_they_are.

Don't you know that the amount of drugs that you give absolutely defines how good of a medic you are? You ain't crap if you don't dope everyone up on as much ketamine and fentanyl and possible.

Cuz the ED docs don't know what they are doing. Or something like that.

My god why don't you get up from your knees and relax.

 

[RocketMedic]

Thank you, NYBLS. Sadly, Remi and a few other members of this board seem to believe that they are both infallible and that those who disagree with them are heretics.

 

[Carlos Danger]

Thank you, NYBLS. Sadly, Remi and a few other members of this board seem to believe that they are both infallible and that those who disagree with them are heretics.

That's pretty funny coming from the guy with the 1-year paramedic certification who tells ED physicians that they don't know what they are talking about.

 

[RocketMedic]

Oh puhleeeeeeeze....seriously?

Not every patient needs drugs, particularly narcotics. They are NOT the solution to everything. And the measure of a good paramedic is NOT determined by how much "analgesia" they give.

Yeah, this patient CERTAINLY doesn't need HORRIBLE BIG PHATMA DRUGS THAT ARE ABUSED AND ADDICTIVE for pain. It's an experience, savor it!

 

[RocketMedic]

That's pretty funny coming from the guy with the 1-year paramedic certification who tells ED physicians that they don't know what they are talking about.

NYC doesn't seem to be a sycophant, though. Why don't you tell us some more how good positioning and an ice pack is better pain control than good positioning, an ice pack, inflammation control and opiates at appropriate doses?

 

[RocketMedic]

That's pretty funny coming from the guy with the 1-year paramedic certification who tells ED physicians that they don't know what they are talking about.

And you have what again?

 

[RocketMedic]

PTSD and refusal of payment because you didn't get narc'd up for a patellar reduction? Seriously?

Look, just stop. Really. You are embarrassing yourself and you don't even know enough to realize it.

#doingwhattheEDdoesbutat70mph



Pfft. Srsly doc? What do you know? You'd give 100mg of ketamine before doing a patellar reduction if you had any clue what you were doing!

And positioning? That silliness is for EMT's - just like mask ventilation. I'm a freakin' PARAMEDIC, dammit! I gots fentanyl and ET tubes!



Oh yes_they_are.

Don't you know that the amount of drugs that you give absolutely defines how good of a medic you are? You ain't crap if you don't dope everyone up on as much ketamine and fentanyl and possible.

Cuz the ED docs don't know what they are doing. Or something like that.

And you aren't doing much good if your literal only service provided is a ride, Ambulance Driver.

 

[Carlos Danger]

And you have what again?

My education is irrelevant here, because I'm not the one telling people who are obviously much more highly educated than me that I know their jobs better than they do.

You don't even realize how badly you embarrass yourself by constantly bragging about all the drugs you can give and telling jwk and medicsb that they don't know what they are talking about. Your understanding of and experience with analgesia is a mere drop in the bucket compared to theirs.

None of this would matter to me at all if it weren't so obvious that these attitudes continue to be part of the reason why EMS still has a hard time finding a seat at the table.

 

[triemal04]

I'm just going to leave this here again. The really sad part is not that it needs to be said again, but that there clearly are far, FAR FAR to many people in EMS who truly believe, and act, like this.

Whoa whoa whoa there tiger.

MY ego is the only thing that matters in this job. Because I'm a life saving heart-breaking hero! I mean a super badass clinician! I mean the future of EMS! I'm so good I run rings around doctors and my top notch department gives me everything I need to save lives. In fact I'm so good I can make a difference just by thinking about it. How do I know this? Why let me just tell you.

I'm so good I can do whatever I want whenever I want; if I see some procedure done on youtube and I think it's appropriate...well I just go out and start doing it! Pfffft...data you say? Proof of effectiveness you say? Correlation to clinical outcomes? Ain't nobody got time for that!

My drug box is so big it takes 3 people to carry it. It's got more drugs than most ER's. My ambulance has a ultrasound, a portable x-ray and hauls a trailer with a CT scanner. When a new gadget hits the market we have it on the trucks before anyone else. We've got every automated device ever made for EMS and believe me, I use them all. Training you say? Appropriateness of medical interventions you ask? Pffft...I'm just so good I don't need to worry about that, just like my whole department. And you know we're that good because we do all these high-speed low-drag things that nobody else does.

Get with the program people; we need to show the world our worth! We've got to prove how good paramedics are! And how do you prove that? Why, you push as many drugs as possible and perform every procedure under the sun! Duh! It ain't rocket science kids!

In fact, I think I'm the Chuck Norris of EMS.

Cheers psycho boy.

 

[RocketMedic]

My education is irrelevant here, because I'm not the one telling people who are obviously much more highly educated than me that I know their jobs better than they do.

You don't even realize how badly you embarrass yourself by constantly bragging about all the drugs you can give and telling jwk and medicsb that they don't know what they are talking about. Your understanding of and experience with analgesia is a mere drop in the bucket compared to theirs.

None of this would matter to me at all if it weren't so obvious that these attitudes continue to be part of the reason why EMS still has a hard time finding a seat at the table.

Sounds like a cop-out, Remi. I am pointing out that people, including physicians, are not correct solely because of their education- for example, as a somewhat-competent provider of medical services (albeit not as skilled, educated or legally enabled as a physician), I think it is poor care to leave a person in pain until they are fixed when one could both remove the pain and rapidly fix the underlying problem. It is better service to alleviate pain quickly and effectively than it is to leave someone to sit until their turn in the treatment queue comes up. Decades of repetitive experience via anecdote doesn't change that.

The real problem with this industry is not compassionate, competent, educated people like me willing to recognize that good medical care is also good customer service. It's with fools like yourself who believe that lack of legal ability or support to teach us to manage conditions like this justifies converting entire swathes of our service into glorified taxi rides on the basis of cost efficiency...and it's with the culture that associates acute pain relief with crime, addiction and dependency, a culture you and many others seem to have bought into wholeheartedly.

 

[RocketMedic]

I'm just going to leave this here again. The really sad part is not that it needs to be said again, but that there clearly are far, FAR FAR to many people in EMS who truly believe, and act, like this.

Whoa whoa whoa there tiger.

MY ego is the only thing that matters in this job. Because I'm a life saving heart-breaking hero! I mean a super badass clinician! I mean the future of EMS! I'm so good I run rings around doctors and my top notch department gives me everything I need to save lives. In fact I'm so good I can make a difference just by thinking about it. How do I know this? Why let me just tell you.

I'm so good I can do whatever I want whenever I want; if I see some procedure done on youtube and I think it's appropriate...well I just go out and start doing it! Pfffft...data you say? Proof of effectiveness you say? Correlation to clinical outcomes? Ain't nobody got time for that!

My drug box is so big it takes 3 people to carry it. It's got more drugs than most ER's. My ambulance has a ultrasound, a portable x-ray and hauls a trailer with a CT scanner. When a new gadget hits the market we have it on the trucks before anyone else. We've got every automated device ever made for EMS and believe me, I use them all. Training you say? Appropriateness of medical interventions you ask? Pffft...I'm just so good I don't need to worry about that, just like my whole department. And you know we're that good because we do all these high-speed low-drag things that nobody else does.

Get with the program people; we need to show the world our worth! We've got to prove how good paramedics are! And how do you prove that? Why, you push as many drugs as possible and perform every procedure under the sun! Duh! It ain't rocket science kids!

In fact, I think I'm the Chuck Norris of EMS.

Cheers psycho boy.

You're simply a trolling idiot.

For what it's worth, we will one day have access to reasonable developments of these tools and we will change and expand what we can do for our patients. It is not out of the question that we could one day replace direct in-facility physician consultation for many issues, and bypass facilities and physicians that may be appropriate per marketing and protocol, but are not optimal (this is already done in many places). Trolls like you put up strawmen and belittle folks like me, but science willing, we will be shown to be right.

 

[RocketMedic]

My objection to the show is simple- it showcases the exact opposite system design from what I prefer. It does a good job of humanizing employees and patients, but it also spotlights what they do (or don't do) and solidifies an impression of us as technicians. Imagine if that police officer's patella had been here in Texas, in a system that allows its medics to reduce dislocations (and mine does not, sadly- it would be a valuable skill to learn, but that's another argument). Instead of a BLS ride, it could have literally been pain management, acute problem resolution, immobilization, training and crutches and referral to an orthopedist for follow-up or a surgeon if needed- we could literally have replaced the ED. Now imagine televising that care and demonstrating that we can do more than CPR and drive- imagine showing definitively that we can solve a problem, spare an ED visit and turn an unpleasant multi-hour experience into a simple bad day?

Instead of that, Save My Life and Boston EMS turn injuries into entertainment and our profession into goodhearted, powerless people-movers.

 

[epipusher]

I'm in full agreement with Rocket on this one.