Occupational Hazards

Lt. Ray McCormack of the FDNY made a statement at the recent FDIC conference: the fire service needs a "culture of extinguishment not safety." Some of Lt. McCormack's remarks seem pretty inflammatory, but they're the same thoughts that I've occasionally had. Now, I'm just a volunteer firefighter on the Oregon coast, but if an FDNY lieutenant and a small town volunteer firefighter think the same thought, there must be a few people in the middle that feel the same.

I've been involved in the fire service for over 8 years and have worked as a full time EMT/Medic for 5. Even in that time, especially considering the post 9/11 period, emergency services are focusing more and more upon "ultimate" responder safety. As Lt. McCormack puts it:

"Attempting to make the job safer by teaching you to place yourself above those in need is wrong and goes against everything the fire service has ever stood for."

When I first started taking my fire service and EMT training, safety was a matter that was pressed upon us heavily. But it was always prefaced with a statement of: we're doing what no one else wants to do or can do. To put it another way: firefighters rush in while others are rushing out. What we do is inherently dangerous.

Police officers wear bullet proof vests and carry guns because they know they can be shot on any given shift. Firefighters wear turnouts and SCBAs because we know we're entering IDLH atmospheres. EMTs work and move around in the back of the moving ambulance because we know we have to taken care of our patients.

Safety has to be a concern of every emergency responder, but we all do our jobs understanding that there are certain, unavoidable occupational hazards. Even though a firefighter wears his turnouts and SCBA, he knows he may still die in a fire and even though an officer wears his vest, he knows he could die of a gunshot wound. As a medic, I know that when I'm not wearing my seatbelt in the back of the ambulance, that I could die if we get in an accident. My patient is restrained in the 5-point harness, but I take certain occupational risks to render care to my patient.

But I agree with Lt. McCormack that our evolving culture of safety is beginning to hinder our ability to do our jobs. As a medical professional, I attend conferences and read the professional journals. I'm aware of the crash helmets and restraint systems that are being advertised to the EMS community to make us "safer." Several months ago, my supervisors returned from a conference intent upon equipping us with crash helmets. It really just seems too much.

From the fire service, we're required to purchase SCBAs with PASS alarm devices that automatically engage and are engineered with Universal Air Connections (UACs) for the purpose of transfilling the tank. We are required to have RIT teams standing by, ready to spring into action at the first transmission of a "mayday." But in all the case studies the I've ready, I've yet to see a single one where these measures made the live-saving difference.

Lt. McCormack puts it this way: "If you put out the fire, safety is accomplished for everyone on the fireground." And he's right. Getting the job done quickly and efficiently keeps the situation from escalating too much, from becoming too complex, and as a reslut, will keep everyone safer. Our focus in emergency services needs to be on educating responders about a common sense approach to safety. And it also needs to be reinforcing the idea that what we do is dangerous and it is irresponsible to think that we can ever make our jobs 100% safe.

AMA

Overheard on the dispatch:

"Medic 2 respond code 3 for a traumatic injury; female with her hand slammed in a car door."

My partner's response: "that's not a traumatic injury, that's a dramatic injury!"

Laughed we did. But a few minutes later...

"Medic 2 from 44-51--we're on scene with a conscious female patient. Obvious deformity of the left hand, partial amputation at the wrist."

Ouch.

Another few minutes later, after Medic 2 arrived: "MedComm from Medic 2, we're clear with a signed patient refusal."

It begs the question: WTF?

Modest Recognition

So I was standing in line at the vet's office the other day. I was in my uniform since I'd just gotten off shift and was getting some prednisone for Boomer. Dr. Goza's office is always packed with people and pets; he's a great doc and very reasonably priced.

As I'm waiting, one of the vet techs walks out from an exam room, looks up from his paperwork and sees me: "hey, you saved my daughters life!"

My first reaction was to look around for who he was talking to. I know I had that are you talking to me? "I'm sorry?" was the only thing I could say. Usually, I can remember the 'we saved a life' calls.

"Yeah, it was during the snow storm this winter." He was all smiles as he was talking to me. I felt awkward because I didn't have clue what he was talking about and now I was holding up the line.

"I'm sorry, but are you sure it was me?" I didn't want to be rude, but I didn't want to be taking someone else's credit, either.

"Yeah," he went on. "Remember, you gave her an epinephrine shot after she had some peanuts. You saved her."

"Oh yeah! I remember now." And I did. We had been dispatched for an allergic reaction on top of one of the hills in town. I was concerned about making it to the scene since the roads were still snow covered and we'd already had a few instances of slipping and sliding.

But we pulled up to the house without incident, grabbed our kits, and headed up the front steps. Dad met us at the door, his little 18 month old in his arms. She was crying quietly, swollen in her faces, arms, and legs--all over really. It wasn't a matter of hives per se, but swelling all over. She looked miserable, but still awake and afraid of me, so I heaved a sigh of relief.

Dad told us he'd fed her some peanut butter, no big deal since she'd had it before, but she quickly developed a reaction. He had given her benadryl before calling 911, but she hadn't gotten much better in the last 45-minutes. He said he would have taken her to the ER himself, but he had a 3 year old to look after also.

I sat dad and baby down and took a quick listen to her lungs. They were tight and wheezy, so I had my partner get the epi ready while I talked to dad. A quick shot in the rump and we were ready to go. Dad sat in back with me with his other little girl in the airway seat. And within a minute or so of leaving the scene, baby was crying her little head off and sounding much better than when we first walked through the door.

***

I stuck out my hand for the vet tech, "how's she doing?"

"She's great--no more peanut butter for her, though."

We chatted for a few moments more. "I just wanted to say thank you. You guys do such great work."

"You're welcome." It was the most modest thing I could think to say. I front of an office full of people, I felt pretty humble and didn't want to ruin it by saying something non-challant like, "just doing my job, sir."

One of my EMT instructor used to tell us that if we were in teh job for the pay or the recognition, then we should best look somewhere else. I have to say though, it's nice when the recognition happens.

"Free" Health Care

Oregon has what's called the Oregon Health Plan--in essence, Medicaid for those without medicaid. Only a certain portion of the population have access to it and you must meet a certain low-income level to be eligible. It provides access to the health care system that some folks otherwise may not have had. Plan participants get extremely low premiums, low co-pays, and prescription drug coverage. Sounds great, right? Health care for those who wouldn't normally have it.

Here's my problem:

My partner and I took a call for back pain. We were in this closet sized apartment, packed to the breaking point with a couch, queen bed, recliner, kitchen nook, and big-ass TV with stacks of X-Box and Playstation games. All of this in the same little, tiny space. We could barely find a place to set our bags down, let alone stand.

Our patient was sitting in the recliner, moaning and with three yappy dogs circling around us. "So, what's going on?" I ask with a smile on my face.

She was a slow talker and while I felt impatient listening to her get to the point of her story, I listened attentively, taking occasional notes on my glove. But the gist of it all: she had a whiplash injury from about a week ago, had shoulder and upper back pain, and her prescribed pain meds weren't working. It hurt when she moved, hurt when she was lying down, hurt when she was just sitting up.

"So whiplash from a week ago, huh? What happened? Was it a car accident?" Just a curious, conversational, innocent question.

"No... I fell asleep in my recliner and pulled something." Now trust me, given my overall impression of the patient, this was a WTF? Seriously? You called for this?

I know that my partner had the same thought because I could see it in his face across the tiny little apartment. But, I thought that I could use this as an educational moment.

"You know, I'm more than happy to take you to the ER now, but this is something that can easily be followed up with your doctor. Do you have a primary care physician?"

"No. I'm in between doctors right now."

"Well, that's okay. Did you know that there's an urgent care clinic at the hospital and you can easily follow up with a physician there?"

"No. But I'm on OHP and I want to go to the emergency room. That's where I went first, they have all my records, that's where my caseworker knows I'm going to go."

So there it was. I tried to reason once more, explaining that records can be shared, but she wasn't having it.

From personal experience, I'm irritated with the mindset of the 'average' OHP clients that I've run on. They look at EMS and the ER system as their only option and in some cases, as free health care. Now, I know that there are OHP clients that use the system appropriately and I've run on them too, but from my experience as a prehospital care provider, they are the minority.

But the story goes on. I ask her to walk outside to the gurney because there was no way the gurney would fit into her little apartment. She used her cane and I let her hold my hand as we slowly made our way outside. She sat down with a huff, slung her legs onto the cot, and handed me her cane. Then she turned to her son, shouting over me shoulder: "I'll call you when I'm done so you can come get me."

I was left asking myself the question if she's able to walk to my cot (which is next to her parked car) and junior will be coming to pick her up from the ER, how come junior couldn't drive her up to the hospital? I could make the assumption that she just wanted pain medications, but I had already told her up front after looking at her pain medications that I had nothing stronger than what she was already taking. May she simply didn't know better, but I find that doubtful since when I tried to educate her, she wanted nothing to do with it.

Nope, I think it all has to do with her OHP Golden Ticket and her (nearly) free access to healthcare--no matter how unnecessary the access might be.