Category Archives: Paramedic Pundits

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CPR’s Unrealistic Portrayal on the Small Screen

Goofy CPR scene

“Ah, c’mon! There’s no way they would ever do that!”

A resounding Shhhhhhhhhhh! from the multitude cuts me off. “Seriously?” I continue, undaunted. “That patient doesn’t even have an . . . .”

A now capitalized SHHHHHHHH! reverberates off the living room wall, accentuated with a hail of Orville Redenbacher popcorn leveled toward my person, missing my mouth completely.

This is just a small playback of what it was like back in the day, when I was a fiery fresh medic watching a medical-themed TV show with my family. After all, I wanted to impress my kinfolks with my vast knowledge of newly acquired emergency medical protocols and medical terminology that had more than two syllables. It was my civic duty to point out the medical inaccuracies I bore witness to, in the scripts and actions of the TV characters while at the same time ruining the entertainment factor.

Medical shows during that time were just turning the corner from portraying doctors like Ben Casey, Dr. Kildare, and Marcus Welby – the purely altruistic, modest, always accessible, flawless heroes (without personal problems) to a cast of newly defined medical sorts who had their own issues of bad health, bad rivalries, bad relationships and bad breath. Though refreshing, revealing doctors as being human with vulnerable souls can be a little disconcerting, if one is a patient about to get a vasectomy from a physician who just found out her boyfriend cheated on her.

An added benefit to these new medical TV series, such as St. Elsewhere, ER, Chicago Hope and House, was the medical consultants to actually make an attempt at following medical guidelines. (Grey’s Anatomy had so much sex going on that nobody had time to treat anyone unless an STD was involved.)

Regardless of this somewhat decent attempt to entertain yet educate the audience to the detailed innards of emergency medicine, there are still a few scripted practices that get on my nerves – regardless of my ability to appreciate the fact that maximum drama impact will always supersede medical facts.

A few notable inaccuracies include: a patient diagnosis made within minutes of arrival to the ER and without a team consult; doctors actually performing procedures themselves; doctors ever yelling “stat” or stethoscopes not angled forward in the ears; coma patients with nasal cannulae; patients in flatline being defibrillated; patients’ survival dependent on a bullet being extracted immediately; gunshot wounds to the shoulder or leg considered minor inconveniences and, finally, EMS providers portrayed as mindless stretcher-bearers having performed no prehospital care whatsoever prior to their destination.

As television screenplay writers continue to strive to make their storylines more clinically precise (thank you, WebMD), there’s still one cinematic medical procedure no one seems willing to amend despite its blatant inaccuracy from both a physiological and psychological level.

You know the scene I’m talking about: The patient is pulseless and apneic and yet within a few minutes of bystander CPR and occasional words of encouragement (slapping optional), the patient, with beautiful skin color by the way, elicits a few coughs (sans emesis), blinks their eyelids as if waking from a nap and then says in a neurologically intact kinda way, “What happened?,” all the while never grabbing their now freshly fragmented and misaligned thorax. Such successful resuscitations transpire 75% of the time, assuming you’re fortunate enough to code on TV as a nonexpendable character. Clinically dead patients brought back to life is a central component to medical shows, but when it comes to CPR, fact and fiction often become blurred.

This kind of CPR (clean, pretty and reliable) differs so much from my usual CPR (can’t possibly recover) that despite the ongoing changes I’ve been trying to keep up with in regard to evidence-based CPR protocols, I’m beginning to think maybe EMS needs to take a page from Hollywood to enhance patient survivability from a cardiac arrest. This might include a new verbal algorithm when all other scientific-based efforts of resuscitation have failed. Hey, what can it hurt after your fourth round of epi and 10,000th chest compression?

Medic: Patient is still pulseless and apneic.

Team Leader: Raises shaking fist to the sky, yelling. Not today! Not on my watch!

M: Still asystolic.

TL: Grabs patient’s collar with both hands. Don’t quit on me (patient name)! Fight, damn you! Fight!

M: Still negative on the pulses.

TL: Looks toward the heavens, howling. Why him/her?! Why? Why? Why?!

M: Still got nada.

TL: Don’t take him/her! Take me instead! … No. Wait! Points to partner. Take him instead!

M: Gasp! Cough! Gurgle!

Seriously, I believe the falsehoods of CPR (cinematic pulseless recovery) have created a community disservice for the sake of highly impressionable entertainment. The film industry should take on the civic responsibility to enhance the perception of CPR factually–especially when dealing with scripts of surviving family members struggling in their effort to seek realistic expectations of full code resuscitation for a dying loved one. Even if the patient survives a cardiac arrest following CPR, full neurological recovery is not as cut and dry as portrayed on the screen. Now that the viewing audience has openly embraced the explicitness and particulars of medicine being put out by the film industry, let’s not skirt the complicated medical and ethical issues of CPR the medical community, patients and family members need to consider. At least not on my watch.

(We thank Steve Berry, a Paramedic with Southwest Teller County EMS in Colorado. He is the author of the cartoon book series “I’m Not An Ambulance Driver.” His work can be seen at: www.iamnotanambulancedriver.com)

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Doctors: So Which ‘Witch’ is Worse?

Witch Doctor Christopher Omigie
Witch Doctor Christopher Omigie

In Beaumont Texas a Nigerian “witch doctor” will spend the next 14 years in a Texas prison, after state law enforcement determined that he had amassed hundreds of thousands of dollars by offering ghostly protection for local drug pushers.

Christopher Omigie, age 58, who emigrated to the United States and set up residence in the city of Lafayette, Louisiana, was sentenced yesterday in Beaumont federal court. He had changed his “not guilty” plea to “guilty” in a narcotic distribution conspiracy.

According to U.S. Attorney John Bales, Omigie would routinely take cash and drugs in return for magic ointment massages; Tarot card readings; powders with supernatural powers and other items, to guarantee the drug dealers would be immune to the prying eyes of police.

The drug dealers under his “care” learned to talk to magic rocks and take no showers after their magic treatments in order to retain the potency of the magic. Magic “law stay away” candles were lit around them, to protect the drug traffickers from being caught by law enforcement.

Here’s another look:

http://www.kltv.com/story/28946332/nigerian-witch-doctor-sentenced-to-14-years-for-east-texas-drug-trafficking

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Our Take:

We have no problem at all with drug-dealing witch doctors being sent off to jail.

We do have serious concerns about the ridiculous U.S. Immigration system.

And we are flat-out appalled at why this sick twist gets 14 years for playing giddy ghost games while Conrad Murray got 24 months for killing Michael Jackson.

Does any of this make sense to you?

My Lunch With Sonny Bono . . .

My friend Sonny Bono
My friend Sonny Bono

It was a few weeks later (after the Palm Springs Girl Scout bus crash) when I found myself sitting at a table, amazingly, having a quiet lunch with the famous Sonny Bono. No need for reservations – it was his restaurant. It was also his idea. The layout of Bono’s was extraordinary enough to mention, with world-class tennis courts on each side of the building and plenty of windows to watch the action. The courts were flawless green and set lower than the landscape, providing a bird’s-eye view from the tables inside. That was no accident, either. Sonny wanted his celebrity friends to feel comfortable, without the annoyance of the desert wind. And he knew very well that paying customers would flock to a place where they could watch people as famous as he was, running around in shorts. I couldn’t help but notice some of the shorts myself.

Johnny Carson was out there, engaged in a serious match with somebody, and Stefanie Powers sat with elegant ankles crossed, sipping something cold under an umbrella. Her television show, Hart to Hart, came immediately to mind. I smiled to myself. On some days the village of Palm Springs can honestly bumfuzzle the brain.

Inside, the penne pasta was delicious. Mayor Bono had listened to my opening spiel and now he sat with his fork suspended above his plate, staring at me in rapt attention. The expression on his face was one of utter shock.

“Are you honestly saying that this county – our county – is deranged enough to pull your Paramedic license because we used that helicopter?

“Not the whole county,” I answered. “Just the EMS part.”

“How can anybody be that pea-brained?”

I shrugged. “The helicopter was not EMS-certified. Not the aircraft, not the pilot. They were never approved to transport patients.”

He plunked his fork down and screwed up his face as if the whole world had gone mad. “That helicopter was a godsend out there. It was like . . . divine intervention! What kind of fools would let those girls lay out there in pain a minute longer than they had to?”

“The kind of fools who don’t like medics making independent decisions.”

“So what about the taxis?” he said. “I suppose we shouldn’t have used them, either.”

I sighed. “To tell you the truth, I’m surprised they didn’t make that an issue, too.”

He groaned. “There’s something wrong in the heads of people who think like this. They were probably normal till they got a little authority.”

I toyed with my iced tea. “I had about 30 seconds out there to make a decision. It made perfect sense. You saw the traffic mess. I made eye contact with the battalion chief who was busy on his radio at the time. We pointed to the chopper and we both nodded. He agreed, but it was my call. I don’t know that he even had time to talk to the pilot. That puts my certification on the line.”

He shook his head. “Sometimes I’m ashamed to call myself an American.”

My sentiment exactly. I swallowed some food and spoke quietly. “Mr. Bono, you’re a decent man. You were the most humane person out there. It took me a week to realize that. And because of that decency, you’ll probably never understand what I’m going to say next.” I paused to stress my point. “For all the good it does, rescue does not exalt moral courage at all. To the contrary, it squelches fortitude almost by reflex. In the world of EMS, saving lives is not the priority. Following every rule every time, is the priority. You get creative; try too hard to save people? That’s the fast track to a short career.”

Sonny cringed as though in pain and I suspect he probably was. His rock star days were behind him now. He was a normal person these days and this peek into the Twilight Zone was like a kick to the stomach.

He said, “Do you know why I became Mayor of Palm Springs?”

“Not really, no,” I replied.

“I ran for office because some small-minded bureaucratic twits wouldn’t let me put a sign up for this restaurant.”

“Wow. So instead of fighting city hall, you became city hall.”

“Sometimes you’ve just got to out-sneak the bastards.”

I nodded. “Well, you certainly have a great sign out there now.”

We sat silent for a time as we finished our lunch, but when he spoke again his voice grew lower, calmer, filled with resolve. There was none of the high-pitched nervousness that seemed his norm. I realized there was more to this man than being Cher’s former husband, or the overly emotional fellow in the presence of dying teenagers. Sonny Bono had not gotten where he was by dodging challenges.

He leaned forward in his seat and narrowed his eyes. “I have an idea that might work. By God, they are NOT taking away your Paramedic license.”

(And thanks to the marvelously sneaky Sonny Bono, they never did)

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At one point during our lunch Sonny Bono had asked, “So in other words, we’ve reached a point where a rescuer can’t say ‘screw the rules’ and just do the right thing?”

Not in other words, Sonny. Those are the perfect words.

 

Immutable Law #2

Saving lives is not our priority.

Following our policies is our priority.

Protecting ourselves comes next. Avoiding

lawsuits comes third. You come somewhere

after that.

(Excerpt from the book. “Paramedic Heretic”)

 

A Day in the Life of a Paramedic . . .

The following story is related word-for-word by a veteran Paramedic:

T SHIRT

Chest pain at an urgent-care facility. A female in her 40s, according to the dispatch notes. For all we know, this could be a 93-year-old male with a bunion. Silly call takers.

This time, they got it right.

“She is 43,” the physician on staff informs us. “Her chest has been hurting since 11 o’clock last night, and she needs to go to the emergency room. Her EKG is abnormal” he goes on, as he hands me a 12-lead.

It’s a sinus rhythm in the 70s with not a thing wrong. I couldn’t draw one better with a ruler and 6 hours of practice. But it says “Abnormal EKG” at the top.

I guess ‘reading EKGs’ is the same as ‘reading the words at the top of the EKG’ to some people.

“Hi, I’m ‘C’ from the ambulance, how are you doing today?” I ask the very matronly, middle-eastern appearing woman in the room. I notice she is fully clothed, and wonder how an accurate EKG was obtained through a sweater, long sleeve shirt, and bra.

I suppose she could have gotten dressed after disrobing, but I doubt it.

“I’m fine, I guess. What are you guys doing here?” She looks genuinely puzzled.

“Well, the doctor called us and thinks you should go to the emergency room because your chest hurts.”

“I threw up 5 times last night and it made my throat burn. Where did he get chest pain? I don’t want to go to the hospital.”

The doctor walks in the room; “Yes ma’am, these nice ambulance people are going to take you to the hospital to make sure everything is alright.”

“But I don’t want to go to the hospital!” she retorts.

“I really think it is in your best interest” the doctor replies as he walks out of the room.

She acquiesces to the suggestion, but seems hesitant. I’m not too concerned just yet.

“Let’s move you into the ambulance, and get a few things done, and just go from there.”

After loading her in the ambulance, and several uncomfortable moments while she undresses from the waist up, with her modesty maintained, of course, her EKG still looks better than mine. Try and try, I can’t find anything wrong with it. Her vital signs are more than fantastic. Excellent, actually.

We determine that she vomited several times during the night after eating sushi and having drinks with her friends. Her throat and nostrils were burning, but her pain was gone now. Drinking milk or cold liquids seemed to help the situation. Then she says the magic words:
“I don’t want to go to the hospital.”

We do the whole rigmarole with the refusal paperwork, and she signs the form, saying she will go to the hospital if she ever needs to, but will never come back to this place.

I don’t blame her.

She gets dressed again, and steps out of the ambulance, walks to her car, then drives off. After we rearrange the ambulance and put the equipment back, I step out of the side door, to be met by the same doctor from inside with a very disapproving look on his face.

“Just what do you think you are doing?”

“Getting in the ambulance, and going in service” I reply. “The patient didn’t want to go to the hospital.”

“She has to go, I’m the doctor, and that’s why I called the ambulance.”

“Maybe if you had explained to her that you wanted her to go to the hospital by ambulance, she could have told you she didn’t want to go, and you wouldn’t have wasted her time.”

(Courtesy of http://captainchairconfessions.com/2013/01/28/physician-vs-patient-vs-paramedic/)

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“America’s Dumbest Doctors” – Laugh, Cry, Get Smarter about Healthcare

 

ADD PHOTO
Who do Paramedics turn their patients over to? Well, far too often, it’s these characters.

 

In this non-fiction study of physician misconduct, we learn for the first time what happens when a paramedic focuses his penlight on the idiocy around him and unleashes 30 years of note-taking. In America’s Dumbest Doctors, author Patrick McDonald has produced a book that literally no one else has dared to publish, detailing exactly who the ‘bad guys’ are: licensed professionals inappropriately held in such high esteem by the public.

McDonald, a traditionally trained EMS program graduate of UCSD School of Medicine in La Jolla, not only reveals first-hand instances of doctors behaving badly, but includes revelations from nurses, the media, and physicians, who themselves are so often embarrassed by their peers.

Consider the Arizona MD who – while facing 67 counts of sexually abusing his patients – announced in court, “Okay, so I’m not exactly Dr. Marcus Welby.”

Or take the East Coast doctor who stole a cadaver’s hand in order to impress a topless dancer. Or the Tennessee MD who wrote to Bank of America, “This person is dead. She is green and has maggots crawling on her. Stop asking about her status.”

A retired chief of medicine from San Diego said this: “McDonald breaks rank and names names. I wish I could report that these are merely a few far-out nutcases. I honestly cannot say that. And this fact alone makes his work, regrettably, important.”

The comedy of America’s Dumbest Doctors will entertain you. The sheer volume of idiocy will educate you. And the book itself will probably save lives.

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     “Do not let the title fool you. The value of this book lies not only in its hilarious incidents (which are abundant), but in the truly bizarre antics by way too many healthcare practitioners (the sheer numbers are astonishing). The author invited medical professionals nationwide to speak their minds on quirky physician behavior, and yikes, did they ever. The result is an eye-opening view of doctors, which is just shocking.

“Each chapter takes a different viewpoint and in between are hundreds of actual news headlines, which advances the book’s scary premise: No other profession spawns more ludicrous conduct. There’s the highly-educated MD who tried to seduce a topless dancer with the severed hand of a cadaver; the famous diet doctor who spanked his nurse’s bare bottom with a riding crop when she ate something fattening; and on and on. It’s really a rollercoaster ride, so fasten your seatbelts! I had the pleasure of interviewing the author on my radio show.”

Jacqueline Marcell

– Jacqueline Marcell, Author ‘Elder Rage, or Take My Father… Please! How to Survive Caring for Aging Parents’, International Speaker on Eldercare & Alzheimer’s

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‘Patient Privacy?’ Don’t Count on it – Paramedic Heretic Examines the New ‘Normal’

 

Welcome to the world of electronic medical data
Welcome to the world of electronic medical data banks

 

The ugliness of healthcare hacking cases impacts the medical and financial status of nearly 100,000,000 citizens. And the numbers are growing.

You would need a Ouija Board to even guess the impact of the shocking number of patient data breaches in the current world of healthcare. Just this week, health insurance provider Premera Blue Cross disclosed that hackers have broken into its system and breached the privacy of 11,000,000 citizens. A Premera spokeswoman reports that their computer systems were hacked  as far back as last Spring. She states they were totally unaware of the data theft for seven months. She did not explain why on earth they waited three more months to tell their patients. Here is a list of what we now know was accessed by the bad guys. We sincerely hope your information is not on this list:

  • Social Security numbers
  • Bank Accounts
  • Insurance Claims information
  • Medical Charting details
  • Dates of Birth
  • Telephone numbers
  • Member IDs