Tuesday, September 2, 2008

Points of View

We did a really good job, I'm not afraid to say it.

The guy was having a MI and we caught it on the ECG despite a baseline altered mental status and no clear chief complaint. We treated appropriately and gave a report on the way to the hospital that got the cath lab open and waiting for us. Door to balloon time was under 15 minutes, a lifesaving success for which my partner and I proudly accept our portion of the credit.

We followed the patient right up to the cath lab and bore witness as our inferior/lateral/posterior ST segment elevations gave way to a serious occlusion of the proximal circumflex artery. It was exactly where we thought it might be, and in the darkened surgery suite, my partner and I beamed.

We got some handshakes and genuine praise from the ED doctors. They said we did an excellent job, that they wished every call went this way, and that we should keep up the good work. It was only a few kind words but it meant the world to us.

Our supervisor was waiting for us when we returned to the ambulance. He was there when we arrived with the patient, and it seems he noticed in our haste we had forgotten to secure one of the four straps that hold our patient to the stretcher. The other three where in place, but I had removed the top strap because it was causing artifact on the twelve-lead ECG.

Pulling the yellow carbon copy from his stack of citations, he handed me my notice. "You should have put the straps back together before taking the patient out of the ambulance." A written warning. Next offense I'll get suspended.

Out of the clouds, Baby Medic. Back to reality.


Brick City Medic said...

Your supervisor is an idiot.

Strong work all-around though.

Brett said...

Ahhh see this is why we have a union... LOL

Anonymous said...

Den't let a s***head supervisor take you down from the clouds where you are deservedly walking!

brendan said...

Grade-A moron. I don't care what kind of great calls I'd get working there- you couldn't pay me enough to work under micromanagement like that.

This jackass represents everything that's wrong with the Evil Empire.

fiznat said...

Thanks everyone. This particular supervisor isn't even that bad of a guy. ...Its just interesting sometimes how various "points of view" can see the same events so differently. Despite all the fancy ECGs, drugs, and cath-lab, we're still ambulance drivers subject to the same mundane rules as any other shift-punching blue-collar worker. Supervisors will always be up our ass for stuff like this, and no matter how well a call goes from one angle, there will always be something else on the other side. I suppose someone else might say that we would have REALLY done well here if we had held the "safety" stuff in as high regard as we did the medicine.

brendan said...

Forgot to mention- just the fact that you had three whole straps puts you head and shoulders above 90% of the EMS services in my area.

If I call 911 right now and told a good enough story to even get a stretcher, I'd have one strap on me. ONE. I @#$% you not.

Bob said...

Do you have an email address for the supervisor?

I just wanted to let him know he is a prick.

Anonymous said...

Hmm where I work we only have three straps on the cot. Feet, waist and chest.

4 seems a bit much.

Connie said...

I'm a paramedic in Nova Scotia, Canada. I have a supervisor like yours too, Fiznat. No matter how well you do a call, or if you help save someone's life, my supervisor always has to dampen the mood, and make us feel like shit.

I think it must be a pre-requisite of becoming a supervisor? Being a dickhead?

I'd never make a good supervisor then, because I'd actually praise my employees if they did something well!

Good job, Fiznat!

Mastabattas said...

I think the reason for why you removed the belt should be taken into consideration before giving you a warning of any kind.

However it IS interesting to me in light of the recent recall on a particular model of Ferno stretchers. At my service, we had one collapse and the only reason the patient was not harmed was because all of the straps of the 5-pt harness were being used (this includes the shoulder straps). I doubt this is why the shoulder straps were ever designed but it is a rather random example of how it was a good thing they were there. Incidentally, the colleague at the foot end of the stretcher (which was the end that collapsed) is off work due to a fracture to his lower leg just below his knew (as a result of this incident).

At the other service I work for we only utilize the three belts which to me is actually a concern. I would rather have an overkill of belts then too few.

Sounds like you had a beautiful call Baby where everything came together perfectly. I wish your supervisor could have taken that into consideration prior to bursting your bubble like that.

brendan said...

Anonymous, federal law requires you use the three straps you have plus two shoulder straps- so there's actually 5.

No stretcher is sold without them, and no manufacturer condones having a patient on their stretcher without all straps secured.

The shoulder straps will be the only thing that saves your patient in a front-end collision. It's been proven time and time again.

Unfortunately, you can't tell most fire departments that.

zac said...

*chuckle* well, I suppose your supervisor is just a grade-A douchebag then. Nice work on the transport, by the way.

Anonymous said...


While i don't doubt that the 5 point straps are safer i am not familiar witha federal law saying they are required. I know nowhere in my county or the surronding counties are anymore then three used.

I have actually advocated for the shoulder straps for just that reason(front end collision). I have gotten alot of gripping on the other end about money and all the usual BS.

Anonymous said...

Your supervisor can shove it up his A$$. If your supervisor does not know; paramedics are in a major shortage in plenty of areas. Since you have your sights on medical or PA school; why don't you check into Acadian Ambulance in Louisiana. I am not talking about going into 'hurricane island'. They have plenty of "markets" where they are offering a $20,000 cash bonus for two years of service. Since the salary is 35K plus, you can scrimp and save 10K a year and do overtime. After that, you can jump to AMR and receive their 10K bonus in some of their "markets". After those hoops are jumped through you can go to Caribbean medical school which is two years abroad and two years at a hospital in NYC. Then you can go back to your old town and write your supervisor up for his pis pore attitude.


brendan said...

While i don't doubt that the 5 point straps are safer i am not familiar witha federal law saying they are required.

Common Carrier statue. It doesn't mention straps specifically, but an EMS lawsuit by the family of a patient killed due to unused shoulder straps found that ambulance services , by virtue of Common Carrier, "owe patients the highest measure of safety possible," and that this constitutes "preventing lateral and longitudinal movement" during transport.

In a nutshell, they found that the patient in the case, ejected from the stretcher and killed on impact with the inside wall of the ambulance during a routine transfer, was not provided his due protection as required by the Common Carrier.

End result was a rather large settlement and a policy that failure to use the shoulder straps constituted a terminable offense.

DH(A HA)PD said...

While we don't work at the same place it sounds sadly identical!

PDXEMT said...

Love the company. We don't have tickets yet out here, but I'm sure it's coming.

I think in that situation I would have to keep my mouth shut to keep out of more trouble.

Why not reward good patient care and good behavior?

Oh, right ... cuz we gotta make money on transports and keep from getting sued. The medical care is secondary.


Sounds like a sweet job on the STEMI.

Anonymous said...

brendan, I just googled every variation I could think of on what you said and failed to find a single website or case law or court decision confirming that.

Do you have a link for us?

MedicThree said...

God... That crap drives me nuts. During my internship my preceptor wouldn't let me open the doors till all the straps were in place(and they use the shoulder strap setup). PITA.

Seriously, The patient survived the insane traffic to get there, but you don't want them slipping out of the other 3 straps to fall off the cot!