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:
I stood convinced that health care was fairly insulated from petty infighting so prevalent in less meaningful professions.
I was certain that saving lives was the highest of its priorities.
I took for granted that scientific integrity was somehow a given; that there were too many safeguards to allow fraudulent research to harm patients.
I believed physicians were held to the loftiest of discipline standards.
I was sure the most prolific drug profiteers on the planet were tucked away in jungle hideouts.
And it was revolting – quite viscerally painful – to concede that not a single one of those beliefs happens to be true.
So what is the purpose of the Paramedic Heretic? Simple. It is time for somebody in my field of expertise to shout “gardyloo!” from the belfry. It is time that you – health care’s ultimate consumer – gain the perspective of just how distorted our corner of medicine has 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 we just don’t think like you do. 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.”
Make no mistake. Much of what goes on within the monastic world of medicine is brainsick beyond belief, fashioned in part by some rather ignoble dynamics. For brevity, we call these the Immutable Laws.
You won’t be hearing about the Immutable Laws on the network news. You will not absorb them from the internet. If you happen to have medical friends it is unlikely they will fess up, either. In fact, we in EMS don’t even admit the Immutable Laws exist.
Time for the cleansing light of day.
Oh, and one more thing? We always spell Paramedic with a capital ‘P’. We think we’ve earned it.
Within days after she acknowledged widespread failure to meet national EMS standards on dispatch times, the director of the District of Columbia’s 911 center has been forced to resign, according to a city hall spokesman.
Jennifer A. Greene, who rose through the ranks of the DC police department for more than 30 years, had served as head of the Unified Communications Center for the past five years.
Greene’s tenure in the communication center was a tough act to manage. Recently one of her greatest challenges was the matter of firefighter delays in responding to a deadly Metro tunnel fire. Another incident was one in which a medic closest to a choking toddler was not dispatched to the scene. The boy later died.
During a hearing in March, Greene faced severe criticism from D.C. Council member Kenyan McDuffie, chairman of the Judiciary Committee, who questioned why average city dispatch times were consistently more than a minute longer than a national standard of 90 seconds.
“Did your center ever meet that internal one-minute-and-30-second standard?” McDuffie asked.
Greene answered no, saying the dispatch center was looking at changing its internal standard to “something more realistic to shoot for.” She said, “We just haven’t made that standard, so we need to look at it; we’ve been talking about it for over a year.”
Wanda Gattison, a spokeswoman for the 911 agency, said Greene agreed to resign Sunday night. Gattison said Christopher Geldart, Director of the D.C. Homeland Security and Emergency Management Agency, will head the 911 center temporarily. Greene’s salary was $185,000 a year.
The 911 center had been under scrutiny since the Metro tunnel incident on January 12. That fire killed one woman and left numerous others trapped in a train as smoke filled the underground tunnel. The National Transportation Safety Board has not yet completed the investigation, and Metro and fire officials have come under scrutiny.
Firefighters reported that they were slowed on that disaster by poor radio communications and were forced to rely on personal cellphones. There has been much controversy between Metro and the District over whether underground relays, designed to boost EMS communication signal strength, were properly tested.
Greene was in charge also when the fire department implemented a new computer tablet system, to track fire engines and ambulances and improve dispatch times by sending the closest rescue teams to emergencies. The DC fire union complained about frequent system breakdowns.
That acknowledgment came after a young child – who choked on grapes in his family’s Northwest Washington home – died. A Paramedic team very close-by was not dispatched, as the computer system mistakenly sent an ambulance from much further away.
Officials said that Paramedics closest to the scene had not properly logged themselves as ‘in service’, but the fire union argued that computer tablets often lost their signal as the ambulances moved around town. This caused the $13,000,000 system to send faulty information to the dispatch center.
Here are a few little goofy matters to think about this Holiday weekend:
Electric hand dryers in public restrooms are more sanitary than paper towels
Not in our opinion.
While we certainly tip our fedora to the eco-friendliness of these screaming meanies, we do not in any way believe they are as sanitary as using paper towels. More than a dozen studies reveal that not only do blow dryers scatter bacteria all over the bathroom; they are resented by 50% of the folks faced with using them.
So the unintended consequence is? Well, millions of pee-peers every day, not washing their hands at all.
Ewwww. The Kitchen sink is the germiest thing in the house
Nope. The kitchen sink can indeed be a bacteria incubator, but it does get occasional splashes of soap and hot water. The biggest cootie culprits in town are can openers; rubber spatulas; blenders and the “crisper’ drawers in the refrigerator. And the critters on that frig handle could likely attack kittens on the front lawn.
Sponges are a bright idea when cleaning up
Not even close. Sponges might make you feel better by shining up the bigger cootie clumps, but they don’t seriously clean the countertop. They do give food germs a little recreational relocation. Think of your favorite sponge as an RV for bacteria. The typical kitchen sponge can – and probably does – act as a nice open-top bus ride, for millions of germs just waiting for their next cruise across the counter.
Now, if you are totally in love with your sponges, at least zap them in the microwave now and then.
But by far your wiser choice is a fresh paper towel.
Antibacterial soap protects you from germs
Even hospital staff make this mistake. Of course, hospital ‘nosocomial’ infections kill 75,000 citizens a year. (We’ll do the easy math for you. That’s 200 dead people every day) So don’t look to your local hospital for advice on cleanliness. Big mistake.
Not one existing study shows that antibacterial gels are any more effective than good ol’ soap and water for washing hands, when it comes to protecting us from boogies.
So now you can relax an go grill something on the patio.
And we won’t talk about BBQ grill bacteria today. That would be un-American.
“EMS personnel have an occupational fatality rate of 9.6 per 100,000 workers per year, in transportation-related incidents. The death rate is 6.3 for police; 4.5 for firefighters and 2 for average citizens.” (National Institute for Occupational Safety & Health)
Because you chose us for your daily dose of reality therapy, we will inform you right now that Code-3 (lights & siren) ambulance responses happen thousands of times a day for no good reason. In spite of what plenty of fine folks have come to believe – maybe even you – the fact is EMS ‘shock & awe’ is rarely a significant influencer in saving lives by getting to the patient faster. Neither does it usually improve patient outcomes by getting them to the ER a blink or two quicker. More than a few studies have shown that – contrary to the convictions of the EMS world – Code-3 driving puts medics; their patients; other responders and the public in unnecessary peril. So much so that, by all measurable criteria, the routine practice quite possibly generates as much trauma and death as it prevents. Now, how smart can that be really?
The tradition of flipping on lights & sirens by ambulance teams has, over seven decades, morphed into a reflex so axiomatic that few people on either side of the EMS equation give it much real thought. It just is. Code-3 has been elevated to a sacramental practice which now sports all the hallmarks of – as comedian Stephen Colbert likes to say – ‘truthiness.’ It must be right because it feels right.
Code-3 is religious dogma because, well, by God, it’s an emergency. It appeals to our sense of righteousness.
“Let’s go! Fast is good, faster is better!”
No, actually, it isn’t.
Just because something feels like warm and fuzzy common sense, doesn’t mean that it is. In five out of eight lights & siren responses you happen to witness on city streets on a given day, those fine folks in uniform are dashing off to no true emergency at all. In nearly every one of the other three cases, arriving one, two or three minutes later would have no downside whatsoever.
As far back as 20 years ago, research conducted for the Annals of Emergency Medicine determined that the time getting from the scene of an incident to the emergency room, in a given city, was 43 seconds slower without lights and sirens. And while this difference in ambulance time may seem important to the citizenry – it is certainly not important medically.
In layman’s terms, delivering you to the ER 43 seconds faster, does not mean hospital staff can work magic within those extra seconds to improve your situation. In fact, 5-10 minute delays are almost never clinically important either.
A few minutes saved were probably once clinically valuable in a fraction of cases, in the era when speed was all an ambulance had to offer. For the most part, detailed physical assessment and advanced-level intervention just did not happen with unskilled care providers of the times. But today there exists practically no circumstance where “a minute lost is a patient lost.” In fact and in most cases, the first half-dozen things that a doctor and nurse would do, have already been done. That is what basic and advanced life support gets you. It’s why we master medicine instead of drag racing.
For nigh on 40 years the eight-minute response time has been the platinum standard for the value of EMS to its community. The “we’re quicker than the other guys” mentality has dominated practically every EMS contract conversation since Emergency.
In the era of the Gold Rush the mantra of the macho was, “who’s the fastest gun in the West?” In the outré world of EMS, it still is. Playing the speedy-medic card is – to a great extent – exactly how the largest EMS provider in the U.S. won all those lucrative contracts. American Medical Response succeeded in leveraging the fuzzy math of quicker ambulances, to convince 2,000+ communities that parking Paramedics on street corners means faster times and by default, a better way to do things.
Not even close. Quite the opposite, in fact. The unintended consequences are astronomical.
What it guarantees instead is a never-ending stream of twenty-something burned-out medics with often not much in the life-experience bucket, using the revolving door of AMR to gain a modicum of street-cred while they shop for a ‘real’ job. And real positions – if you ask them, anyway – mean you’re not parked at Poco Taco assuaging your stress with a burrito after treating a bloody mess. To the contrary, rescuers should be afforded the simple decency of being allowed to return to a crew quarters; take a shower and decompress from the god-awful mess they just experienced. Mind you, medics don’t require much in order to do the job properly. A shower and a bunk, a fresh shirt and a padded cell would cut staff turn-over by 90%.
In the bizarre world of EMS, this nation’s largest care provider subscribes to the same theory of staff hiring and turnover as McDonald’s hamburgers: mediocrity works just fine, and they can always find new medics for less money when the experienced ones can’t take it anymore.
Our antiquated, arranged marriage of ‘quick response’ to ‘the best interest of the public’ is but one aspect of health care that turns logic on its dizzy head. Distilled to its lowest common denominator, private carrier EMS has convinced you of this little mind-bend:
“Don’t worry. We’ll save you, even if it ends careers; trashes a noble profession; bankrupts half of us and kills people.”
The 32-year-old anesthesiologist was found guilty in April of multiple crimes committed after a Christmas party with her coworkers in December 2013. A concerned Derry taxi driver had driven her to a city police station from a bar, where she reportedly became violent. Doctor Kerr, who lives in nearby Marlborough Park, testified in court that she had no memory of the events that night.
Upon her release from the police station she had blood tests taken at a local hospital and traces of the ‘date rape’ drug GHB were discovered.
The Londonderry Magistrates Court judge said at the time of her conviction that he was convinced her drink had indeed been tampered with, but explained that “involuntary intoxication” was not a legal defense for violence. The wayward doctor apparently assaulted several police officers twice that night. She was given a two-month conditional discharge.
The doctor reports that criminal convictions have put her medical career at risk.
In Dallas an MD who operated a sham, cash-only clinic has exhausted his legal appeals and will continue to sit in a federal prison cell for another 11 years.
Doctor Nicolas A. Padron, who had lived in the Dallas suburb of Garland, was sentenced by U.S. District Judge Barbara Lynn to 87 months last October. Padron had wisely changed his “not guilty’ plea to “guilty” in September 2013, to Conspiracy to Distribute Narcotics. Judge Lynn then ordered the wayward physician to forfeit all bank accounts; two luxury cars; his home and a boat,
U.S. Attorney Sarah R. Saldaña of the Northern District of Texas, announced that the prosecution proved its case, that Padron and co-conspirator Jose L. Martinez opened Padron Wellness Clinic, located at 1000 Emerald Isle Drive in Dallas in October 2010. PWC’s sole function was to operate as a “pill mill” – a lucrative drug dealing center on the pretense of a clinic. Martinez, age 54, was convicted at trial in February 2014 on conspiracy to unlawfully distribute narcotics and is awaiting sentencing.
Others involved who were also sentenced:
Joseph Austin, age 60, was sentenced to seven years
Patricia A. Bryant, age 60, was sentenced to four and a half years
Dennis J. Wade, age 36, was sentenced to 21 months
Allen C. Burkins Jr., age 43, awaiting sentencing
All four acted as drug dealers recruiting fake “patients,” many from homeless shelters, driven in minivans in groups to the so-called clinic. The dealers would routinely walk the people into the clinic, coordinate with Martinez, and pay cash for the office visits. Doctor Padron would often see several patients at the same time in an exam room, where they would be issued 30-day prescriptions for 120 pills of hydrocodone and up to 90 pills of alprazolam. Padron would ‘diagnose” the drug users and sellers with “lower back pain” and
“anxiety disorder.” Treatment was non-existent, and the “prescriptions” were medically unnecessary and outside the scope of his professional practice.
The co-conspirator dealers would then drive groups of patients to Urban Independent Pharmacy, located at 6300 Samuel Blvd., in Dallas, to get the prescriptions filled. Convicted co-conspirator and pharmacist Lisa Hollier, age 44, of Sunnyvale, owned and operated the pharmacy. She would fill the bogus prescriptions without question. She was convicted last year and given a five-year term in federal prison.
At Urban Independent Pharmacy, Lisa Hollier would accumulate large amounts of hydrocodone and alprazolam in pre-filled containers, to meet the demands of all the customers pouring in from the make-believe medical clinic. The dealers would give money to the street people to pay for the drugs in the parking lot. After Hollier filled the prescriptions, the street people would give the dealers the pills, which they sold on the street for a profit. the homeless folks would be driven back to where they had been found, with a little cash in their pockets.
Daffy Doc Padron is already serving time on an unrelated case, one in which his role as the “medical director” of something called A Medical House Calls, got him into trouble. In that scam he paid doctor visits to Medicare patients in their homes; made up medical problems; charged their insurance to fix the imaginary conditions. At trial, Padron was also ordered to repay the $9,000,000 he stole from Medicare and Medicaid in that scheme.
A total of 17 conspirators have been locked up in this case alone. Here’s more: