Book Excerpt: The Paramedic Heretic – Immutable Laws & Ethical illusions

K. Patrick McDonald shares an excerpt from his book which he describes as 'a veteran medic’s unvarnished 30-year critique of EMS'

Editor's Note: This is an excerpt from the opening chapter of the "Paramedic Heretic." The author, a veteran paramedic who has responded to more than 20,000 calls, details how policies often undermine patient care and defines what he calls the "Immutable Laws" that reign supreme in the business of saving lives.

By K. Patrick McDonald 

I wasn’t always a heretic, of course. In my salad days I was as blissfully ignorant as interns tend to be, cheerfully willing to chomp onto the shiny, enticing fishhook called ‘rescue’ with no fear of consequence. Newbie’s to most professions, I suppose, are sodden with more limerence than common sense, and those of us who fairly leap into the quicksand of the emergency disciplines can be as career-infatuated as anybody. The rhetoric of disease and cure is, after all, highly seductive. In fact it’s downright sexy. That’s why so many of us do it.

Dashing from cadaver lab to classroom to library, we surely resembled puppies with our heads out the car window. We were on a mission, we interns, teeming with the zeal of the righteous. We would have gleefully run over grandmothers in a crosswalk to get to a good emergency. It’s that magnetic, isn’t it?

"Hi. My name is Rick. My brother and I have created an extrication device. We’re wondering if you guys on Lifesaver 1 would be willing to field test it and give us some feedback from a paramedic point of view."
Rick Kendrick, who invented the KED

And so we did.

Those were heady times, for the late 70’s had all the trappings of the Renaissance. We were, after all, the pride of our campus – UCSD School of Medicine – in the chrysalis of advanced pre-hospital disciplines. There were just not many earthlings doing what we were. EMS textbooks were literally being written by the bright folks who whirled around us each day, and many of our own San Diego ideas then, are standard protocols now. The books tucked under our arms were physicians’ books – Taber’s and Dubin and Merck et al. Among the first medics in the U.S., we were 19 neophytes in lab coats, armed with shiny new stethoscopes, convictions that refused to dwindle and unmatched energies of troopers on point. You could not have stopped us with a freight train. Some of the best-known newscasters in the nation got their start on the same university campus we did. And they often tagged along with cameras to file their rookie news reports on our training adventures, as part of their UCSD Visual Arts Program.

We saw ourselves as warriors, prepping for the nobility of battle. We were yet to learn that rescue medicine – at least the rendition practiced on the metropolitan streets of America – was more warlike than anything we could imagine. It was a war where the most deeply wounded were often, strangely, the caregivers. For the cloistered dimension of EMS was rife with ‘friendly fire’ and grew more so by the year. This of course leads to the logical question of why any normal person would choose the profession. Well, most ‘normal’ citizens do not. But in our unmitigated zeal to get to the meat of lifesaving, it would have served us well to curb our soaring sense of wonder long enough to notice the enigmas of rescue, for they are often confounding. Being of sane mind, we might have at least grown wary of the maelstrom. We might have turned and fled the other direction. The sad truth is that in the beginning it is simply not possible for the bewitched intern to fathom the essence of EMS, nor its undercurrents of sheer madness. For these are kept quite deliberately hidden.

"We suffer from ‘Maximal Response’ disease and red lights and sirens are the symptoms."
Jeff J. Clawson MD, Author, Principles of Emergency Medical Dispatch

So no, I certainly did not start out a skeptic and I would guess that almost nobody does. In my formative years I was as goofily naïve as anybody. So what is the purpose of the Paramedic Heretic? Simple. It is time for somebody in our field of expertise to shout "gardyloo!" from the belfry. It is time that both citizenry and the medics who serve them – health care’s ultimate consumers – gain the perspective of just how distorted some aspects in our corner of medicine have become. The goal here is entirely uncomplicated. You will almost certainly have need to call 911 for medical help at some point in your life, so you might want to read up, because Paramedics just don’t think like non-Paramedics. Before this book is finished you will know exactly how we think, which might come in handy on your next personal emergency.

What you have here is a veteran medic’s unvarnished 30-year critique. A professional bloodline; a pilgrimage to heresy. If you are wise beyond your years, you will become a heretic, too. At the very least, when you put this book down you will know – as the marvelous Paul Harvey used to say – "The rest of the story."


Reprinted from Paramedic Heretic with permission of the author

Copyright @ 2014 K. Patrick McDonald

Published by Dog Ear Publishing

Available on Amazon and wherever books are sold.

About the Author

K. Patrick McDonald is a graduate of UCSD La Jolla School of Medicine's original Advanced Field Medicine program. He was appointed the first EMS Supervisor for the City of San Diego under Mayor (and then Governor) Pete Wilson's administration. He created one of the nation's first STAR (Special Trauma & Rescue) Teams in 1979, and co-authored the "San Diego City Disaster Preparedness Plan." He is a co-author of the "National Waterpark Lifeguard Training Manual." He has acted as consultant to the U.S. Secret Service in Presidential Protection matters and to the U.S. Embassy, Vientiane, Laos.

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