The people I work for don’t want me to tell you this, but…

This teenager blows his knee out stopping at 3rd base, an uncomplicated deceleration injury, but he seems more interested in watching his team play anyway.

For some reason, his mother calls 911.

“I just want to make sure he’s OK.”

I look at her quizzically, “OK? He’s not even paying attention to us.”

“The last time he hurt his knee, the ambulance told me that he’d be seen faster if we went with them.”

I can guarantee that no paramedic would ever say something stupid like that.

“Ma’am, from the guy who’s had 4 knee surgeries to the mother of someone’s who’s probably going to have knee surgery, you should take him to an orthopedic surgeon, not the emergency room.”

What’s crazy is that even in 2014, there are some back-ass-ward managers and local oversight agencies who still insist we take everyone to the ED.

It’s only your body

“What medical problems do you have?”

“I just had surgery.”

“What kind of surgery?”

“Colonoscopy I think. Something like that.”

“Well, that’s not really surgery. Or did you actually have surgery? They remove something?”

“Colonosc-something. I don’t know.”

OK whatever. I’ve lost interest anyway.

Two minutes later, I lift her shirt up as I always get around to looking under clothes.

A colostomy bag. And bandages. Not just a little bit different from a colonoscopy.

“So you had some colon and maybe other stuff removed.”

I don’t even bother asking why stuff was removed.

“I told you I had surgery,” she looks at me with annoyance written across her face.

“Except you didn’t know anything about your surgery when I asked.”

This is another area where I really have a problem with the concept of consent. People don’t understand anything. “Informed consent” is an illusion in the great majority of cases – are you really going to hang your hat on the average civilian’s ability to care for him/herself? Those of you who are still worried about that kidnapping/false imprisonment charge or are always so quick to let people refuse care against their best interests, perhaps you should think again.

Zero Tolerance means Zero Thinking

Apparently, there is no more thinking required.

The Boston Herald has a story about North Andover High School honors student Erin Cox, who is being punished for running afoul of the school’s zero-tolerance alcohol policy, all because she – sober and being a good friend – went to pick up a friend who had been drinking and asked for a ride.

“Don’t let friends drive drunk,” we tell our kids. “If you’ve been drinking, call mom or dad to come get you — no questions asked,” we tell them, too. “And if you can’t call your parents, call a sober friend.”

Ms. Cox, being responsible beyond her years and bearing absolutely no resemblance to the unbelievably depressing immaturity of the general public or the staggering inflexibility and hubris of the school, did exactly as we always tell children.

But, the police happened to show up at the same time at the party, and despite having her sobriety confirmed in writing by an officer, she had her captaincy on the volleyball team stripped from her in addition to being handed a 5-game suspension.

CNN has a few snippets of people, with even less sense than the school, actually defending the punishment, citing zero tolerance. Following their logic, it’s “The hell with her friend because there’s alcohol on site,” and, “Rules are rules even if it’s stupid!

Now, assuming the principal facts of this story is true, since I spend a fair amount of my time in the middle of the debris and destruction left behind by DUIs, I just want to highlight Ms. Cox’s actions in her own words:

Asked if, knowing what she knows now, she was mistaken to get her friend, she said she would do it all over again.

“It was the right thing,” she said.

Indeed, young lady. Indeed.

I’d like some sanity please

Around here, law enforcement officers are nearly always allowed to independently determine their mode of response to a call based on the details. They seldom drive with lights and sirens. And it’s very rare to hear that they chose incorrectly.

In fact, they hold calls and stack them all the time. I’ve seen sergeants cancel responses just based on how stupid it sounds.* I envy them.

Furthermore, many law enforcement agencies don’t even chase anyone in vehicles anymore unless there’s a really, really good reason to chase someone down.

Looking toward the East Coast, a few years ago, FDNY – not exactly a bastion of ultra-progressiveness – stopped responding to a significant portion of their calls with lights and sirens. If FDNY can figure it out, everyone else should be able to figure it out.

Since we all work within the same legal framework, and driving with lights and sirens is very dangerous no matter what type of vehicle is used, and I write often about MPDS and how overly conservative it and the predetermined local responses are, why is it that I can’t choose my mode of response to what often sounds like total bullshit? Trading a few seconds for a much more dangerous ride to stupid calls doesn’t seem sensible at all, yet it is our norm.

We can constantly remind crews to use an abundance of caution, but that doesn’t take into account the unbelievably bone-headed behavior of the driving public in general. This seriously cannot be the way to do our work.

*And there are some really stupid calls.

You can do whatever you want if you’re not EMS

Every 2-3 years, I have to take awful mandatory re-cert classes for CPR, ACLS, PALS/PEPP, ITLS/PHTLS* and God knows what else in order to keep my license. Not only are these classes a huge waste of everyone’s time, the instructors uniformly terrible and without actual street experience, but do you ever get the feeling we, EMS, are the only ones who actually have to follow the treatment guidelines set forth in these classes and subsequently adopted by local policies and protocols? I swear to God, I always see hospital staff doing whatever the hell they want and administering whatever drugs the ED attending can think of. And then they question all the up-to-date, by-the-guidelines treatment we did and did not provide beforehand.

*The timestamp for this link to an earlier post about re-certs is nearly 2 years old. I guess I do get really cranky around re-cert time.

The most important question not asked in MPDS

“I need to send the appropriate number of responders – how much does the patient weigh?”

“He’s 160 pounds.”

“OK, we’re only sending two people then.”

You saw it here first.

Can’t ever win

Basic ED:

“Why didn’t you bring him to the trauma center?”

Trauma center:

“Why did you bring him here to the trauma center?”