Top 10 EMS Events of 2010

Now that EMS crews have exchanged their hot packs for cold packs, and stocking extra blankets instead of bottled water, let's count down the most memorable events of the year

Wow, is it holiday season already? Seems like just the other day I stepped outside to a crisp fall morning and the scent of burning leaves in the air, and it seems like just last month I was treating pollen-induced asthma attacks and heat strokes...

But now that EMS crews everywhere have exchanged their hot packs for cold packs, and stocking extra blankets instead of bottled water, in no time like the first robin of spring, the first dead guy shoveling snow will herald the true arrival of Old Man Winter.

And at, that of course means the observation of our winter ritual: the year in review. Join me now as we count down the Top Ten EMS Events of 2010:

10. The social media revolution: The popularity of shows like Chronicles of EMS and the EMS 2.0 movement demonstrated the positive impact of social media. What they're saying there is not new; in fact, most of their ideas closely mimic the 14-year-old EMS Agenda for the Future. But more than anything else, the skyrocketing popularity of blogging, podcasting, Twitter and Facebook gave the rank-and-file EMT a voice in how that agenda is implemented within their own systems.

Unfortunately, it also gave a voice to thousands of EMTs who run out of functioning neurons before they run out of characters in a Twitter post, and took by surprise many EMS managers and administrators, who are still trying to figure out how to deal with Facebook status updates like this one:

9. Drug shortages: Due to various manufacturing delays and unforeseen higher demand, many common EMS drugs like D50%, glucagon, epinephrine, lidocaine, procainamide and furosemide were on nationwide backorder in 2010, forcing 75 percent of EMS agencies around the country to scramble for alternative packaging, or in some cases, different medications altogether.

Meanwhile, medical directors for the other 25 percent of agencies were heard saying, "Wait a minute, there are EMS systems out there that still use lidocaine, procainamide and furosemide? How...quaint."

8. Helicopter and EMS safety: 2010 saw interesting new developments in EMS transportation safety. NFPA sought to re-invent the KKK 1822 wheel with NFPA 1917, which should certainly make ambulances more expensive, if not safer. Several ambulance coach manufacturers debuted new models that eliminate side-facing bench seats, and in response to the yearly meteor shower of EMS helicopters falling from the sky, the FAA proposed new flight safety standards to include dual pilots, instrument flight systems, night vision gear, and terrain avoidance systems.

Here's a radical idea: Why don't we just stop driving so fast, and stop flying people based on dubious criteria like mechanism of injury and the need to get a ground unit back into service for the theoretical next call?

Nah, that would never work.

7. A patient dies in Pittsburgh, and so does common sense: During the February blizzards that blanketed much of the country, Curtis Mitchell died. After 30 hours and 10 calls to Pittsburgh's 911 center without ever seeing a paramedic, Mr. Mitchell succumbed to his illness. Several responders were suspended and one fired. An investigation revealed that at least two crews asked the patient to walk out to the ambulance when they couldn't reach him, and one crew chief — the one fired — said over an internal communications circuit, "This ain't no cab service."

The incident also reaffirmed the fact that medics make excellent scapegoats for a public officials derelict in their duty, and that EMTs still eat their own kind. Also, in the best closing-the-barn-door-after-the-horse-gets-out fashion, Pittsburgh officials are now making better preparations for heavy snowfalls.

6. AMR Jackson medics get Stoked: Jackson, Miss. city councilman Kenneth Stokes, incensed that AMR medics waited outside a shooting scene until police told them it was safe to enter, suggested,
"You have got to take the risk. You can't let citizens die. Because if you are wounded, you say I'm not safe. Now if you can't assume the risk then give it to the person who can assume the risk."
EMTs around the country rolled their eyes in disbelief, several national EMS organizations publicly endorsed AMR's policy on dangerous scenes, and the chancellor of Thurgood Marshall School of Law in Houston, Texas was heard to moan despairingly, "Oh my God, and we graduated this guy?"

As yet, there has been no confirmation to the rumor that Kenneth Stokes has also designed a line of EMS uniform apparel that consists of red capes and shirts with a big "S" on the chest...

5. Massachusetts EMTs get caught pencil-whipping: Leo Nault, of Concord, Mass. was indicted along with four co-conspirators for conducting (or not conducting, as it were) fraudulent EMT refreshers and certification courses for hundreds of EMTs.

Meanwhile, we have still not answered the central question: Why do we still have CEU and refresher requirements so simplistic and stultifyingly boring that providers will risk decertification and imprisonment to avoid taking them?

4. AHA guidelines changes: CPR class, circa 1990: "Wrong! You were ½ inch off on your 11th compression of that last cycle, and you only gave 78 compressions in one minute! Do it again, maggot!"
CPR class, circa 2000: "Well, halfway-competent CPR is still better than no CPR, and the important thing is, you tried! Group hug, everyone!"

CPR class, circa 2010: "Wrong! You interrupted compressions for 11.2 seconds on that last compressor switch, and you started by checking the airway! Do it again, maggot!"

The importance of uninterrupted chest compressions and the new C-A-B sequence for pulseless arrest forced EMTs to abandon an acronym we've used for generations, which caused great consternation among EMS responders around the country.

Not to worry, though; cops can still use the A-B-C acronym for "Ambulance Be Comin'" and burned out medics can still use it for "Ambulate Before Carry."

No sense throwing out a perfectly serviceable acronym just because it's obsolete, is there?

3. There's a big difference between mostly dead and all dead: Paramedics in Maryland and Little Rock, Ark., learned the hard way that appearances — including ones that suggest the patient has expired — can be deceiving.

Both EMS agencies launched internal investigations and disciplined the medics in question, and at least in the Maryland case, initiated additional training for the medics involved.

No word yet on the rumor that the class was taught by Miracle Max, and consisted of writing on the blackboard 10,000 times, "I will always check a pulse…"

2. Healthcare reform: On March 23, President Obama signed into law the Patient Protection and Affordable Care Act, known to many as Obamacare. The act, among many other things, curtails the ability of private insurers to deny coverage based upon pre-existing conditions, and begins a massive expansion of the Medicaid program.

Its effects on EMS, beneficial or harmful, have yet to be felt. There is no question, however, that it will profoundly affect the delivery of healthcare, and by extension, EMS, in this country for generations to come.

Let's just hope that it doesn't turn out to combine the efficiency of FEMA with the compassion of the IRS and the work ethic of the DMV. As a wise man once said, your choices are good, fast, and cheap.

Pick any two.

1. Oxygen turns out to be just like any other drug: You know, with indications, contraindications and potentially harmful side effects. Since 1994, we have trained EMT-B students with the "If a little is good, 100 percent by non-rebreather is even better," method of oxygen therapy.

Emerging research seems to indicate that high-flow oxygen for MI patients does not improve outcomes, and may even worsen outcomes in stroke and COPD patients.

Who woulda thunk it? Next thing you know, they'll be telling us that antiarrhythmics are cardiotoxic, breathing isn't really important in CPR, and that we should be cooling off cardiac arrest victims instead of warming them up.

Oh, wait a minute...

Happy Holidays, everyone!

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