EMS Dinosaurs Speak!


 
 

Howard Rodenberg, MD, MPH, Dip(FM) | | Friday, December 7, 2007


One of the differences between EMS Dinosaurs and real ones is that the modern kind can write. And write they did this week, with a mixture of reminiscences, legends, cautionary tales, and timeless wisdom.

First, a few kudos for the role of experience:

I read your article on dinosaurs. While there are always medics who long for days past and use it as an excuse not to do what is right, I believe that the one thing us dinosaurs have is a lot of clinical experience and the best ones are the medics who share that clinical base with the newer medics. It is always that 1-in-a-hundred patient that presents the same as other patients but based on history, medications, and other system issues you may want to treat differently. It takes us from the bells and whistles of new technology and cookbook protocols to the area of discretionary treatment based on clinical experience backed by good medical science that really makes the job truly unique and rewarding. That clinical experience is formulated by reviewing every call, following up on the patient through the nurses, residents, and attendings in the E.R. Utilizing cases in the CME call review process as well as keeping up with the pathophysiology and the latest literature on treatment.

Captain Robert Fassetta ( 48 years old / 24 years on the job )

Commanding Officer

FDNY-EMSC Battalion 58

Brooklyn, New York

Dr. Rodenberg,

I just finished reading your article from the JEMS newsletter on EMS dinosaurs and just wanted to drop a quick note saying how much I agree with you. I received my EMT certification in 1972 and my Paramedic Certification in 1975. I am still licensed as a Paramedic here in Alaska (PM license #9) although I don't have much patient contact any more, I became a bureaucrat. I just recently started listening to NPR and have always loved those old rock and roll groups. I am on several state committees and other policy-making groups and I often find myself giving opinions based on my past experience. I have found myself questioning the need for some of the new gizmos that have come out, after all you can tell a lot about your patient if you just look at them, touch them, and talk to them, but as time goes on I find that some of this new technology actually does help. I also believe that we need a good mix of the past and present. Thanks for an interesting article.

David Rockney, MICP

Training Coordinator

Interior Region EMS

Fairbanks, AK

Nice to know I'm not the only one watching and listening to public broadcasting. I feel young enough to be 40.

Some necessary reminders that what we do influences the actions of those who follow:

Alas, Doc, I have to admit I am a T-Rex for sure. In Fire Rescue for nearly 30 years and a paramedic since time began (in Florida at least), I am a legend in my own mind. Never using the "D" word, I've always opted for Seasoned Veteran instead. At least it doesn't make me feel ancient, but I do face the prospect of extinction daily. I gaze into the faces of the "new" generation performing their duties proudly and professionally, and I feel good. I feel good knowing that the knowledge and experience I can pass on to these "newbies" (since I am the EMS Training Chief) may be a small inspiration for their career. These new paramedics seem to constantly need reassurance, guidance and reward, and I am always honored and humbled when they come to me for it, as if I were some paramedic guru. As you say in your article, we lumbered and crawled our way in the beginning, gaining knowledge and experience, unfortunately, through trial and error many times. I've pondered retirement, but I believe, as you do, that we "ancients" can be useful to the new generation. I think I'll stick around a little longer. Who knows, I'll probably need these "kids" someday, and I'll demand perfection.

Thanks for a great article!

Vince Locurto

Battalion Chief

Coral Springs(FL) Fire Department

Training & Public Education Division

I enjoyed your article in the JEMS online email concerning the EMS Dinosaurs, because I happen to be one.

I have been a Paramedic in the great state of TN for about 19 years now. I am the QA and Training Officer, for about 1 1/2 year now, for our County EMS program. This program has been in existence since 1972 and I am one of the two with more than fifteen years experience at the same service (a small rural county of about 30,000) and I am only 38 years old. All others have come and gone and the ones that are left have 10 years or less under their belt.

As you reflected and due to the position that I am in, I try to influence my co-workers to strive and achieve the best they can for the long term survivability of our service and care for the people of our county (someday I may be sick or injured) and that their personalities and positions (the special people that takes care of others in the most undesirable fashions and times for little of nothing and sometimes less) were given to them by God. By doing this I have went back to school within the past 2 years and received my NREMTP and CCEMTP with the hope of showing my guys/girls that us Dinosaurs can still function in the ever changing world of technology.

I try and teach them that no matter how old we get, tomorrow will always be different, so we have to adapt, overcome and achieve, by teaching the old with the new because it makes us better as our time passes on and to be carried to the next generation of EMS providers (as we know things break).

I appreciate your time effort and articles and wish you the best of luck.

Gary Reams, QA/Training, NREMTP, CCEMTP-TN

The best teachers make all the difference:

In response to your comment regarding how EMS has become "a way to make a few extra dollars per hour or to keep EMS faculty in business" ["EMS Dinosaurs" (JEMS Online)] I do have to agree with you to a degree. In many cases, people go into EMS for that "Paramedic incentive". I think this stems, at least in part, from the joining of EMS and Fire Service, however, that's another story. I will say that the way an individual looks at EMS, regardless of place of employment, is completely dependent on the educators he/she was exposed to during training. I have to admit that I came to EMS because I wanted to make a few extra dollars. However, the passion and dedication my instructors put into their teaching quickly made me fall in love with the career and not the notion of EMS. Further, my preceptors while at school and my FTO's since helped develop that love for what we do and who we are. EMS is a family, and as in any family, there will be some black sheep. What we need to do is concentrate on those of us who look forward to riding our trucks for 12 or 24 hours and still, after years of running calls, get excited when we hear our unit being called over the airwaves.

Jorge L. Torres, EMT-P

Medical Administrator

Medcor Construction Medical Services

Orlando, FL

Looking ahead from the window of the past (does EMS get into the blood?):

First of all I would like to say, "I resemble that remark" since I started in the EMS field in 1975 and do listen and watch the Doo Wop shows on PBS (they happen to come from Pittsburgh, home to Dr. Nancy Caroline, and a host of other early EMS pioneers) including myself. I do agree with your assessment of how difficult it is for us to change, but I have tried to keep myself in the present and future of EMS (my daughter is now in Paramedic training and keeps me sharp). Right now I feel that EMS has moved from its infancy into the adolescent years and it will be up to us Dinos to help it mature into adulthood. I look to the future with excitement, for this will someday become once again a field that attracts only the best. Thanks for the article, I really loved it.

Richard Miller

Paramedic Supervisor

Jefferson Hills Area Ambulance

Jefferson Hills, Allegheny County, Pennsylvania

Finally, a wonderful series of "tall tales":

I enjoyed (and agreed with) your article on EMS dinosaurs. Perhaps I can appreciate your article more than the average paramedic of today, as I happen to be one of the dinosaurs! I am 54 years old and I have been a paramedic for 24 years and a basic EMT six years prior to becoming a paramedic...and yes, its true, I do inscribe my paramedic number with a couple of sharp rocks!

I have seen much in the last thirty years. I have also done much. When at last I bow out of the workforce and take my place in the nursing home rocking chair, I will have such memories that I will not have to watch the boob tube or participate in the boring routine planned by the Activities Director, I will just put on the music that I have recorded from my old 45 records (I have over a thousand) onto the media of the new era and then I will harken back to the call that I am reminded of from the most recent thing the nurse says.

I will remember what the fear (we called it "pucker factor" back then) was like to take the paramedic oral boards from the three Emergency Room doctors when I took my final exams in paramedic training. I will remember what it was like to extricate with the most advanced rescue tool of that era (the air chisel). I will remember what it was like to respond to shooting and stabbing calls without a police escort and confronting the attacker. I will remember what it was like to work a cardiac arrest in an ambulance in the summer in hot, humid South Carolina in the newest and most advanced ambulance of the day: a Chevrolet van with the latest climate controlled patient compartment--a fan.

Oh! And I will remember the calls when I used isoproterenol to "speed up" the heart when atropine had no effect on the bradycardic patient. And embarrassingly, I will remember the cardiac arrest saves that we paramedics were so smug about when we followed protocol by intubating, starting an IV and giving 1 mg of epinephrine and 100 mEq of sodium bicarb to every cardiac arrest patient before defibrillating a coarse fibrillation (I suppose that they survived in spite of what we did to them, not because of what we did to them)!

Oh! I will also not forget about the close bond we had with the ER doctors because we got to know them so much better...since we had to call in a report on the patient to get an order for treatment because there were no standing orders except for cardiac arrests. Ah, and then there are the memories of our ambulance's batteries going dead so often because we had regular van alternators that did not allow for the extreme demand for electricity when everything was running during an emergency call.

But I will remember most fondly the days when the paramedics referred to patient care almost reverently...for the patient was the most important aspect of the healthcare system...and the billing dollar was secondary.

And, of course, I will remember very fondly the camaraderie between paramedics and the ER nurses and sitting outside the ER waiting for them to get off work so they could go with us to eat or get a cup of coffee. They were so attractive in those immaculately white dresses, the nurse's caps and not a hair out of place...because there were enough nurses available for proper patient care and it was not such a hard job for them.

Yes, I am so thankful for coming along when I did. It was such a special time...

Patrick E. "Pat" Browning, Sr., SCEMT-P # 327 It's 2330 hrs on my middle shift as a Captain on a Truck Company. I just returned from "the smell of smoke in the area" that revealed nothing, and sat down to write up an incident report. My eye caught your article in JEMS Infomail, and I thought I would just write you and pass on some of those days of the dinosaur.

I was trained as a paramedic through the Stanford Pre-hospital Care Program and graduated in 1977. It was a proud day for me, being a husband and father, attending school so I could work the magic of para-medicine on the citizens of my county. That was Alameda County then. No paramedics, only EMT-1's. Finished in the top 5% of the class, ready for action. Work schedule was 5 24-hour days on then 2 days off, followed by 6 24-hour days on, then 1 day off...repeat. Had to change that schedule fast. Alameda County....no paramedics... Contra Costa County had paramedics and I jumped at the change of employers to work in the field as a paramedic. First group in the county. Work schedule 15 days a month, much better. We were magic in the field, starting IV's giving Dextrose to diabetics, Narcan to Heroin OD's. Defibrillating the cardiac arrests. Great time, however there was a lot of work too. Talk about control issues. Each month had to document IV starts in hospitals, IV meds, IM meds EKG recognition, had to "send strips" to base hospital for conformation of what I saw on our AMPAK monitor/defibrillator (65 lbs, and up to 500 w/s of juice). Must attend base station tape reviews, take a test each time on various continuing education topics. Nurses pulling field IV's out getting to receiving hospitals and then restarting them in a "sterile environment". Yeah, sterile all right! Worked my way through the ranks of the private ambulance company to field supervisor. Then, got hired with a fire department and continued to work as a firefighter/paramedic. Continued to save people's lives working 10 days a month and better pay. Now a Captain, still licensed as a paramedic, and assist with the new breed of paramedic on calls. Once you have it in your blood, it's very difficult to stop.

Just thinking about all the hassles we dinosaurs put up with to be a paramedic. ABAG testing every two years, changes in procedures, standing orders, LifePak monitors, IV needles and needle less injection ports. Can think of a thousand other changes, most for the good, some not so good. Point is that today's paramedics area pushed through paramedic training centers, some are good, some are great, some are supposed to be seeking a different career path. It takes a special individual to be able to think on his/her feet, gather the book knowledge and use it correctly in an environment that you have no control over. I always said, the world's greatest doctor or surgeon can be waiting at the ER door, and if I don't get the patient there alive, it doesn't matter how good they are. Para-medicine is that little space in an emergency that deals with the portion of time the incident occurs and you turn the patient over to the ER staff. So, give me a dinosaur paramedic or give me a 22nd Century paramedic and I'll say combine the two, balance experience with new technology and you will have a great example of what para-medicine should be. Thanks for the memories, I would do it all over again, if I could.

Still amazed about glucometers.... check blood sugar in the field wow.... we used to draw two blood tubes, push dextrose and go.

Robert Glankler EMT-P

City of Vacaville Fire Department

Solano County, CA

My genuine thanks to all those correspondents who took the time to share their thoughts. I hope you enjoyed reading them as much as I did.




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