Explaining Public Safety to Civilians #1: Paperwork

This is how we view the many things that we often don’t want to do through the perspective of paperwork, so we do it anyway:

Why, yes, he is

But, no comment from me.

Code 3 for traffic collision.

Typical bullshit wreck. Everyone should just go on his or her way. But there’s always at least one dude who says his neck hurts. So we C-spine him, longboard and everything. Totally unnecessary. Insuritis. Vaginitis. Labial pain. CYA. Whatever.

Some bystanders are lingering and watching. If you don’t see wrecks all the time, I can understand how you may be curious.

“That guy’s faking it, huh?”

I look at the young women who said it. I shrug.

There really is nothing more to say.

Meet Doug Gansler – he travels Code 3

What on Earth is a state Attorney General doing that is so important and time-sensitive that he needs to travel lights-and-sirens to his destinations?

Let’s for a moment assume this report is accurate, according to The Washington Post,

Maryland Attorney General Douglas F. Gansler regularly ordered state troopers assigned to drive him to turn on the lights and sirens on the way to routine appointments, directing them to speed, run red lights and bypass traffic jams by using the shoulder, according to written accounts by the Maryland State Police.

Here I write regularly about the dangerously stupid practice of responding lights-and-sirens to what nearly always turn out to be completely non-urgent situations, and yet we have an AG – not any kind of actual field emergency responder – running around town like an idiot because he’s impatient.

What. The. Fuck.

By the way, Mr. Gansler, we don’t drive on the right shoulder with lights and sirens. The right is the direction people are supposed to move toward when emergency vehicles running lights and sirens approach. Put two and two together, numbnuts.

I’m so glad that as the state’s top law enforcement officer, Mr. Gansler deems it OK to ignore laws that other people are expected to follow. It’s not like our roads are not filled with thoroughly distracted and/or drunk and/or high assholes without licenses and/or insurance who can’t control their vehicles anyway. Not to mention that he apparently has zero concept of risk, public safety, simple ethics, and what some people would call “just don’t be a douchebag.”

He’s also currently running for Governor, so I’m sure he’ll definitely be needlessly traveling lights-and-sirens everywhere if he’s elected.

Two sets of vital signs

“Please provide at least 2 complete sets of vital signs on EVERY patient, and additional sets of vital signs if a patient’s condition changes, or after an intervention was performed.”

Sound familiar? I’m sure you’ve seen sentences like this in memos issued by the those tough-guy desk jockeys.

EVERY patient? Yeah, right.

When I’m taking James to the hospital for the 11th year in a row for the same thing every shift, you’re lucky if I even bother. In fact, forgive me if I just wait until we get to the ED. I don’t care if you think I’m a bad medic, or a lazy one. His vital signs are irrelevant.

I really don’t see how this is dramatically different than the decision-making process that leads you to omit spinal immobilization or choose one treatment over the other. Patient presents, tells you what s/he wants, you decide what s/he needs and doesn’t need using your knowledge, experience and judgment. James walks up to the ambulance, wants a ride to hospital for the 2,546th time, he needs nothing at all.

He barely needs ONE set of vital signs; he certainly doesn’t need TWO sets of vital signs.

If I’m wrong, you can fire me.

Six times a shift

I know this is going to go nowhere because our bosses are scared of dipshit patients and scumbag lawyers, but as a thought exercise, why is it that fire crews can choose to not respond to repeat alarms and cops can choose to not respond to chronic calls and non-injury wrecks while we go to every single one of our frequent calls? And unlike them, we usually, stupidly, go lights and sirens too. Obviously the cops and the firefighters can decide at the field level what is and what isn’t an legitimate emergency, but we can’t?

We went to the same street corner 6 times in one shift because the resident homeless guy with a movement disorder likes to lie on the ground occasionally when he’s not being handed money, and motorists are apparently too fucking busy NOT paying attention to their driving and instead dialing 911.

I suppose I should just be glad that he leaves at night.

Everybody loves lawyers

We bring a new-onset dysarthria to the ED.

Everyone in the room knows this is a legitimate patient who should go to CT as soon as possible, tPA or not. The attending blows through the NIH Stroke Scale while the staff gets everything else ready.

“CT’s ready. I’ll take her there, OK?”

“No. We gotta scan P first. I wanted him scan yesterday, then this one can go next.”


I do my paperwork, and then nudge one of the nurses in the ribs.

“Hey, what do you have in P that’s so interesting?”

“Nothing. Some anal retentive malpractive lawyer.”

FAQ #2

Q: Why don’t you guys just tell these bullshit patients to fuck off?

A: Lawyers. And chickenshit bosses.