COVID, ketamine, crashes and Craig Manifold: 5 EMS One-Stop lessons 2020

From roadside safety, to recommitting to universal precautions, to promoting public health, reflecting on our journey


As we reach the end of the year that changed our world, its time for a little reflection and a chance to look back on my unique opportunity to author a column which has essentially been a chronicle of a year that spanned from ketamine to COVID-19, and distracted drivers to power napping.

In this article, I am indulging myself and taking a moment to review 5 meaningful topics covered this year to see if my view was 20/20, or blurred and completely out of focus. On counting back, I realize, to my surprise, that this article is my 40th of 2020, and I have enjoyed the opportunity to provide commentary on the year through my lens of EMS experience.

1. Continue to promote roadside safety

We in EMS have a 50-year legacy, but in the last 11 months, we have added chapters to our history that tell of selfless providers on an invisible front line that have given their all, up to and including their lives.
We in EMS have a 50-year legacy, but in the last 11 months, we have added chapters to our history that tell of selfless providers on an invisible front line that have given their all, up to and including their lives. (Photos/Associated Press, Orange County (Calif.) Fire Authority PIO)

Before we got knee-deep into COVID-19 in 2020, there were other serious threats to provider life. These threats haven’t gone away, but have faded into the background in our focus. In February, I wrote about ‘Move Over’ laws and the risks that all first responders, as well as tow truck operators, face when conducting operations on our highways, interstates, streets and roads. I had hoped that one positive from COVID-19 and the reporting from the NEMSIS TAC database showing a downturn in traffic related accidents was that the impact on our own providers would have reduced.

Sadly, this has not been the case. Upon returning the National Move Over Day Facebook page that chronicles all incidents, I was surprised and saddened to see the risks on the highway have not receded. It seems distraction and poor driving, even with fewer vehicles on the road, is still endangering public safety vehicles and their crews.

As case in point, in just the first two weeks of December alone, an Irving, Texas, firefighter was struck by a wrong way driver, a fire truck in Lubbock, Texas, was hit by a drunk driver, and a tow truck driver was struck and killed on Nov. 29 in Anchorage, Alaska. Sadly, it appears that roadway operations are as dangerous now as ever, and we must maintain the pressure on move over laws and the associated penalties for dangerous and reckless driving.

Read: Why we must move ‘Move Over’ up the agenda

2. Don’t fall victim to the rumor mill

I have always been a proponent of public health, and back in March, I zeroed in on the looming pandemic. In the early days of COVID-19, I followed the press conferences held by the World Health Organization and the key leadership exhibited by the WHO Director-General himself, Dr. Tedros Adhanom Ghebreyesus, and his able assistants, Drs. Mike Ryan and Maria Van Kerkhove.

From the early days, they warned us of the politicization of information and, more importantly, disinformation as it relates to the pandemic. Dr Ryan warned that we must be “weary of the bad actors that might use misinformation, the manipulation of information and the misdirection of populations to cause mischief, fear and panic, all of which could occur at the local, national or international level.” He was right – they did.

Even today, disinformation, fake news and state sponsored cybercrime is present. Because of this, we must all make sure the information we take in and believe is from a credible source. The consequence in subscribing to the rumor mill is that it will grind you down quickly and easily, so always check the facts and the originator of any story you hear.

Read: The virus has a new name: Infodemic

3. Learn how to defend the use of ketamine

My coverage of the recent spotlight on ketamine is dear to my heart for several reasons. The main one being that I was assisted in writing the article and in producing the accompanying podcast by the late Dr.Craig Manifold. Craig was passionate about getting the right message out around the ketamine usage issue that emerged in Colorado. Our discussions centered on the use of ketamine in the treatment of excited delirium and in defending its use by medics.

Craig particularly wished to stress that any investigations into the usage issues should be conducted by clinicians with intimate knowledge of the subject as opposed to allowing political views and rhetoric to win the day. In the podcast, more than 3,000 people listened to Craig and I play the roles of reporter and medical director, rehearsing the arguments for the continued use of ketamine. As this issue still seems to be in the news, for those that have the media or elected officials calling, take a minute to listen to Craig’s words on the subject, which I now consider to be a legacy gift from a great and respected man to anyone that must defend the use of this essential drug.

Read: Ketamine administration comes under the spotlight

4. Reflect on the journey

EMS as a profession is relatively young, and in 2020, we passed a major milestone. In California, 50 years ago, on July 15, 1970, then California Governor Ronald Reagan signed into law the Wedworth-Townsend Paramedic Act. The law created the conditions for the establishment of the first accredited paramedic training program in the United States. This act formalized and legalized the practice of paramedicine and the rest, as they say is history.

The article celebrates the achievement and tells the back story as well as the entry of medics into Hollywood History via Johnny, Roy, and the show "Emergency!" While we are young as a profession, sometimes we should stop and reflect on the journey so far, and therefore this story was a particular favorite to both research and write.

Read: The history of our history: 50 years of prehospital medicine

5. Recommit to universal precautions

As we reach the end of 2020, a light has possibly emerged at the end of the tunnel as the first batch of vaccine has been delivered. Delightfully, the internet is now alive with photos of clinicians happily receiving their first Pfizer dose. It seems that confidence is building as our medical directors have now had the chance to examine the science and campaigns such as #EMSVax, initiated by the American Ambulance Association, has been adopted by trade media and national associations.

Our outlook has become optimistic, but (there’s always a but), we must not become complacent, in the words of the WHO’s Dr. Michael Ryan, “We have arrived at Everest base camp – all we have to do now is climb the mountain!” There is still a ways to go and we must not let our adherence to universal precautions and PPE slip. Additionally, the ‘ask’ for EMS will increase as we inevitably will play a part, not only as the giver of vaccinations, but all the other tasks we have taken on this year be it ED augmentation, nursing home backfilling and providing mutual aid to one another.

Read: The word of the week is vaccine

Do not become complacent

COVID-19 has, and is, masking a considerable number of hazards and issues that may not be our foremost focus right now, but must be continuously observed and guarded against. Move over laws and provider highway safety is one area to ensure we look after our own, as is the ongoing opioid crisis that has now been buried away from the headlines but continues unabated.

The infodemic, as described by Tedros and Ryan, has been pervasive and has skewed facts, opinion and judgement. We must all do our best to ensure we understand facts and science over rumor, disinformation and yes, fake news.

We in EMS have a 50-year legacy, but in the last 11 months, we have added chapters to our history that tell of selfless providers on an invisible front line that have given their all, up to and including their lives. While we look to the future, we must also cherish our past.

While the arrival of vaccines has given us hope, we must not become complacent in our approach and attitude to COVID-19. If we do, the light at the end of the tunnel might just be a locomotive heading in our direction, at full speed on a collision course, so focus, even though we are tired, is still required.

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