The good, the bad and the ugly of 2012
From social media to violence against EMS providers, here's the main events of the past 12 months
By Kelly Grayson
Frankly, I hadn't planned to write this column.
I figured with the Mayan Long Calendar ending on December 21, there wouldn't be a need for another year-in-review column, so I spent the days preceding the predicted Mayan Apocalypse stocking up on non-perishable food and ammunition, telling my supervisors what I really thought of them, and preparing to face the end of days with the love of my life, Christina Hendricks, by my side.
Sure, Christina didn't know it, but I figured it was only a matter of time before I'd win her heart. I'm a pretty persuasive guy, and the Mayans had thoughtfully provided me with a ready-made rebuttal to any argument she could offer.
I could picture it in my head: Ash and soot darkening the sky, sirens wailing everywhere, ominous earthquake rumblings underfoot, buildings toppling around us, and Christina wandering the wreckage in a daze, clothing fetchingly ripped, and I'd show up in a hastily commandeered ambulance, offering protection and companionship.
And she'd say, "Look, buddy, I don't know who you are, but I wouldn't get in that rig with you unless you were the last man on the face of the…
… at which point I would look significantly all around me, waggle my eyebrows suggestively and say, "I have a bunker complex in Idaho, and enough Chili-Mac, Twinkies and boxes of white zinfandel to last us ten years. The survival of the human race depends on us."
And she'd fall for it. You know she would.
Silly Mayans. Turns out they can't predict the end of the world any better than SSM can predict where the next call will drop.
So here I sit in my velour bean bag chair; no Christina, no job, drinking fine wine in a mylar bag straight from the spigot, and surrounded by perhaps the last four extant cases of Twinkies and Ding-Dongs in the entire world.
If this isn't the perfect time to reflect, I don't know what is.
So without further ado, I give you the significant EMS events of 2012:
Social media is everywhere now
For good or bad, social media has transformed the way we interact and communicate. While healthcare pundits and policy makers have recognized the potential of social media to speed up and improve EMS communication, many agencies are still struggling to rewrite policies and codes of conduct that never anticipated smartphones with high-resolution cameras enabling communication and information-sharing at the speed of thought.
Some agencies have embraced the potential of social media and harnessed it to improve inter-agency communication and interaction with the public, while others have issued stricter policies, severely limiting employee use of blogs, Facebook and Twitter.
And sadly, some EMTs have given them good reason to be cautious.
Whether your agency's leaders see it as the wave of the future, or live in fear of an employee running out of functioning neurons before he runs out of characters in a Twitter post, social media is here to stay.
The only question is how responsibly we use it. Luckily, there's an app for that.
Natural disasters still tax our EMS systems
In late October, a tropical wave in the western Caribbean intensified and moved eastward. By the time it reached Jamaica, it became Sandy, a Category 2 hurricane and the 18th named storm of the 2012 Atlantic hurricane season.
As Hurricane Sandy tracked north along the U.S. eastern seaboard, it combined with a winter storm to morph into a Category 1 behemoth 1,100 miles across, and made landfall on October 29 near Atlantic City, N.J.
Hurricane Sandy devastated New Jersey and New York with high winds and flooding, and left millions of people along the storm path without power. Damage estimates are currently over $63 billion, with 131 U.S. lives lost.
Many EMS responders risked life and limb to support evacuation and rescue operations, only to find that, when they finally did get a break in operations, they had no homes to return to. And they are still picking up the pieces of their lives.
On Thanksgiving Day, a dense fogbank resulted in a 140-car pileup on Interstate 10 west of Beaumont, Texas, resulting in two fatalities.
Ambulances from Acadian Ambulance, Hamshire EMS, Labelle-Fannett EMS, Winnie-Stowell EMS and Atascocita EMS transported 90 patients, eight of them critical, to area hospitals.
EMS incorporates advances in provider health and safety
As ambulance crashes continue to claim lives of EMS providers and citizens every year, more and more EMS systems are starting to re-evaluate their policies on lights-and-siren use. New ambulances with innovative module layouts featuring safer, forward-facing attendant seats are being offered by most major coach manufacturers.
More agencies are implementing safety and wellness programs and purchasing new equipment aimed at enhancing provider safety and reducing crew injuries. Specialized bariatric ambulances and hydraulic cot-loading systems are becoming commonplace, and this week Hennepin County Medical Center EMS became the largest EMS agency in the world to fully outfit their fleet with the Power Load cot loading system.
We have no word yet on whether this has had a detrimental effect on Ibuprofen and Icy Hot patch sales in Minneapolis, but the crews sure seem happy.
Is violence against EMS providers on the rise?
There is still some debate whether assaults against EMS providers are on the rise, but given the popularity of social media and the exposure to the 24-hour news cycle, it certainly seems that way. The EMS news feeds seemingly have new reports of assaults against providers every day.
The governor of Virginia is considering removing his state's prohibition on EMS personnel carrying licensed concealed weapons on-duty, and the chief of the German Township Fire Department in Clark County, Ohio, is considering allowing his EMTs to go armed.
The issue ignited quite the debate on violence against EMS providers in general and arming EMS providers in particular, with strong points made on both sides of the argument.
EMS advocates are pushing for legislation to make assaults on EMS providers a felony crime, and elected officials in some states are starting to listen.
Unfortunately, even when the law allows for more severe penalties for assaulting EMS providers, some judges still refuse to take it seriously.
At least one paramedic instructor has recognized the need for better provider education in avoiding violent encounters and dealing with violent patients, and has developed a course to fill that need.
As I sat down to write this article, I was receiving tweets about two firefighters in Webster, New York, killed by a gunman who apparently planned the ambush. Two more firefighters were wounded, and the radio traffic of the event is chilling.
The shootings on Christmas Eve will only heighten the provider safety debate, and reinforce the message that our profession is not safe, and not everyone looks at EMS as the good guys.
Evidence-based medicine makes further inroads
In my year-end column five years ago, I called 2007 "The year of the EMT-Basic." The 2005 AHA guidelines had been in place for a little over a year, and incorporated much of the data from OPALS that emphasized the importance of BLS in cardiac arrest resuscitation.
Five years later, the science is even more compelling. Uninterrupted chest compressions and early defibrillation are the only things that we know to work, and both are interventions capable of being provided by laypeople. Recent research even casts doubt on the efficacy of epinephrine and vasopressin in cardiopulmonary arrest. The data seems to indicate that epinephrine and vasopressin are better at temporarily resuscitating a corpse than a placebo, but neither improves survival to hospital discharge.
Taking a step virtually unheard of as little as five years ago, an increasing number of systems are diverging from current AHA guidelines based on their own analysis of the available resuscitation science.
Lake EMS in Florida boasts a 54 percent survival rate to hospital discharge neurologically intact, an outcome substantially better than many systems that follow current AHA ACLS guidelines.
As the science changes faster than the AHA's five-year guidelines revision cycle can adapt, look for this trend to continue.
We may yet reach a point where most cardiac arrests don't even require a paramedic. If that day comes, that's one less instructor card I have to carry in my wallet.
In light of the utter lack of evidence demonstrating benefit of prehospital spinal immobilization, more EMS systems around the country are allowing selective spinal immobilization using the NEXUS low-risk criteria or the Canadian C-Spine Rules.
There is a substantial body of research available on the subject, and despite two Cochrane Reviews of all the available studies, there is still no proven benefit and some evidence of harm with prehospital spinal immobilization – even for patients who actually have spinal injuries.
With that in mind, some EMS systems like Eagle County, Colo., have abandoned the practice of routine spinal immobilization altogether. Did you ever envision an ambulance without spine boards? I certainly didn't.
Healthcare finance will reshape the face of healthcare, and by extension, EMS
In June, the Supreme Court upheld the constitutionality of the Affordable Care Act, commonly referred to as Obamacare. EMS systems are already bracing for changes in reimbursement and anticipated increases in the cost of providing healthcare insurance to employees.
An increasing number are partnering with hospital systems and other stakeholders to form community paramedicine programs, in an effort to provide better cost-efficiency and patient care than the current fee-for-transport system allows.
Whether you enthusiastically supported the legislation or you believe it heralds the beginning of our headlong slide into socialism, it promises to change the way we seek healthcare in this country, how it is provided, and how much we will pay for it.
Exactly how, no one can predict, but it certainly will be interesting to find out.
Spree shooters continue to get more press coverage than their victims, or the rescuers who responded
In July, a gunman opened fire at a movie theater in Aurora, Colo., with a semiautomatic carbine, a Remington 870 pump shotgun, and two semiautomatic pistols. He killed 12 people and injured 59 others.
On December 14, a young man fatally shot 20 children and 6 adult staff members at Sandy Hook Elementary School in Newtown, Conn., before taking his own life. He wounded two others at the school, and authorities later discovered he had murdered his mother and stolen the semiautomatic rifles she owned to use in the attack.
Both of the shootings dominated the news in the days following the events, with objectivity and accuracy all but abandoned by the media in the rush to report the stories first.
Rumors and speculation were debated as if they carried the weight of facts, and in the end only three facts were indisputable: we are seriously lacking an organized system of mental health care in this country, we fail at protecting society from the violent mentally ill, and Americans will change the channel from American Idol and Jersey Shore to watch the news, provided the story is shocking and bloody enough.
And all three of those things do not speak well of our national psyche.
The question before us now is how to balance society's need for security against individual rights and liberties. Where you stand on that issue depends on where you fall on the political spectrum, I suppose. But the one thing I think we can all agree on is that we owe it to the memory of 39 innocent victims to work to see that it never happens again.
It will, but that does not mean we should not try.
Well, that's my 2012 EMS Year in Review; some of it good, some of it bad, and some of it ugly. Next week begins a whole new year, and a new beginning.
And if you happen to see Christina Hendricks, tell her that just because the world didn't end doesn't mean we can't still be together.