People trust us

Blair Bigham

Patients are crazy.  I mean, they must be.  “Sir, I’m going to stick this needle into your chest to remove some fluid from your lung.  Hopefully it makes you feel better.”  His response?  “Okay.”  That’s it.  “Okay.”  Not “Geez, aren’t you kinda young?” (I am) or “Have you ever done that before?” (I haven’t).  Just “Okay.”  Complications include pneumothorax, infection, poking the heart with the needle (I’m sure there is a medical term for this) and death… but I get the thumbs up.

Over the holidays, I had the pleasure of returning to the road (motivation: debt) and working with my friends on both Christmas Eve and New Years Eve (neither of which are Stats).  Eyes opened by my experience as a medical student, where every day you learn that the world of things you don’t know is even bigger than you suspected, I stood back and began to say to myself: “This person is crazy for trusting me.”  We show up and say things that any one of us “in the know” would scrutinize to the ends of the earth.  (Ever called an ambulance?  I didn’t think so).

“Sir, I’m not going to take you the hospital across the street.  Instead, we are going on a 45-minute ride to a Cath Lab.  Hopefully you don’t arrest on the way.”  Does he ask us why or say, “That sounds like a bad idea”?  Nope.  He says “Okay.”

“I’m sorry, Ma’am, but I have to ask the firefighters to cut the roof off your Lexus sedan.”  I know what my response would be.  Hers?  “Okay.”

Every day, we show up in people’s homes.  They tell us secrets.  They let us inspect, palpate and auscultate all sorts of parts that aren’t usually privy to public presentation.  They let us give them drugs, they let us stick needles in them, they let us carry them down the stairs in a rickety chair made circa 1979.  All, for the most part, without a peep.  Just a soft affirmation that they trust us to do what is best for them.

I’m not sure why I never realized this before.  Maybe I did when I was new and forgot as my confidence got the best of me.  If I trusted myself, why shouldn’t they?  But now that I’ve been thrown off my game and placed in a whole different world, I have a new appreciation for the blind trust our patients place in us.  Loathe would they be if my patients knew that for two out of every three procedures I perform, I consulted Wikipedia and YouTube just a few seconds before entering the room.  I mean, really, how am I supposed to remember how to do an ulnar nerve block?  I can barely find an ulnar pulse!  But out comes the needle, and shakily, I start stabbing away.  “Are you done yet?” the patient asks.  “Almost, dear, just a few more seconds (and a bit of luck) and we’ll be all done.”

Don’t even get me started with neurosurgery, cardiac transplants, and end of life conversations.  Surely we must sound ridiculous when we describe drilling through skull, swapping out organs, and allowing death to make its move.  But apparently we don’t; patients place enormous trust in our ability to make good decisions that affect not us, but them.  And for the most part, when our case is laid out, they say “Okay.”

I think back to every time I visited a friend or family member in the hospital, and how little trust I suddenly placed in the very system I have dedicated my professional life to.  Second guessing everything – checking every pump, every lab record, every vital sign.  Perhaps our insider knowledge of what can go wrong taints our ability to trust those who care for people close to us.  The stakes become personal, and trust can be hard to foster.

Most of us have treated patients who are, or whose family members are, health-care professionals.  It is, I think you’d agree, a whole different style of call management.  Our communication changes, our demeanor changes, and we become hyperaware of every little thing we do, every little thing we say, because we know that in order to win the trust of our customers, we have to be that much better.   I don’t take offense to this increased scrutiny; to do so would be hypocrisy.

In fact, I kind of wish every patient would demand this near-perfection from us.  It would motivate me to be diligent, be thorough, be not good enough, but absolutely stellar.  Not some of the time, or most of the time, but every time.  Most patients do not demand this, of course.  They lack the background knowledge, the experiential learning, the trial-and-error moments that develop clinical judgment and wisdom.  And because they lack that, they just trust us.  It’s wholly humbling.  And crazy.

Posted in Insights | Leave a comment

The Toronto Superbus: The bus that changed identities to save lives

Robert Scott, International 2nd VP Toronto Metropolitan Dept. of Amb. Services
and Anne McClellan-Thiel, Staff Writer
Published in the January-February 1979 issue of Canadian Emergency Services News

Toronto has an old bus with a new face. It’s Emergency Unit #5, a most unique emergency vehicle capable of handling 20 casualties at one time. This makes it ideal in the event of any major disaster in the area.

It all came about in 1976, when the general manager of the Metropolitan Toronto Department of Ambulance Services, Mr. John Dean, and his stall foresaw the need for such a vehicle after the bus-train collision in nearby Scarborough in December, 1975, in which ten deaths occurred. Dean obtained a used bus from the Toronto Transit Commission for the price of $7,000, and under the direction of Jim McKellar, a 10-year veteran of the ambulance service, the bus was transformed into a super emergency unit for an additional cost of $8,000.

Ten stretcher positions were installed complete with suction, oxygen, ventilation and inhalation facilities for each of the ten patients. Additionally, such emergency equipment as dressings, gauzes, airways, saline solutions, blankets, pillows, lfnen, etc., were placed on board. The suction is obtained by electrical pumps powered by a 110-volt generator with a backup system from the oxygen supply. All emergency equipment can operate even if the bus engine should fail.

Other oxygen cylinders along with blankets, linen, dressings, ropes and additional supplies are stored in lockers beneath the bus. Washroom and water focilities are also available.

The actual renovation took four months and thanks to Jim McKellar’s knowledge of outfitting mobile homes, all was possible.

Driver training for the unit is taken care of by the TTC.

Ambulance personnel take the standard three-day course civilian bus drivers have to pass in order to be part of the E.S.U. #5 staff.

In April 1977, when the unit first rolled into public use, many citizens were dubious and wondering as to just how many situations would call for such a vehicle. The Ambulance Service had no other choice than to tell them that it was to be on hand wherever large crowd gatherings were to be held or major disasters with multiple injuries were to be expected and a report could be given to those concerned at the end of the year.

As of this time, the vehicle has been used for the following types of calls:
a) Two Alarm Fires – to provide emergency care for the
injured prior to transportation.
b) Large Incidents with ten or more casualties – to provide
emergency aid and shelter and transportation as required.
c) Standby Emergency Care facilities where large
crowds are gathered. such os parades or rock concerts.

Other advantages are provided by the unit. It is less expensive for everyone, patients can be treated and released from the unit, and faster service can be obtained than if the patient were put on standby wailing for a clty-wlde conventional ambulance to arrive. Of course, more serious injuries are still transported to the hospital.

Personnel have found that there is one main advantage of the E.S.U. #5, and that is in the case of post-disaster shock, which can kill even if there are minor injuries.

E.S.U. #5 provides a warm, quiet place for such victims where they can relax and be reassured by personnel.

As you can see, this old bus with its new identity is a welcoming sight for anyone involved in a multiple-victim disaster – firemen, physicians and most important of all, Toronto’s citizens.

CP has this story and more from the January-February 1979 issue of Canadian Emergency Services News in our Classic Issues archives, available for download at http://www.emsnews.com

Posted in Uncategorized | Leave a comment

From the Archives: Heart program not offered to general public: Doctor

Image

Reprinted from the November-December 1978 issue of
Canadian Emergency Services News

The Ontario Heart Foundation and the Ontario Medical Association are not yet prepared to offer courses in cardiopulmonary resuscitation (CPR) to the general public, says Dr. Anthony Webster.

Wester, an anesthetist at St. Joseph’s Hospital in London and a pioneer instructor of CPR courses are currently aimed at “target groups” who are most likely to be in contact with victims of heart disease.

Those in the target groups include nurses, hospital staff having patient contact, dentists, ambulance attendants, policemen, firemen, personnel teaching first aid, high-risk industry workers and eventually the families of cardiac patients.

Webster said the course is only one component of a complex medical emergency system being developed in the province.

Until the system is complete, he said the organizations sponsoring the program believe it “should not be taught widely to the general public.”

Webster said CPR is not necessarily a life-saving technique but can sustain life.

CPR is a difficult procedure and can do more harm than good if not used properly, he said.

The Woodstock chapter of the Heart Foundation began offering the course at the Oxford Regional Centre in January of this year.

The course is filled with local people included in the target group.

But Elaine Reczuch, area coordinator of the foundation, said her office is swamped with calls from people wanting to enrol.

“Every day we have people calling wanting to get into the program. They think it’s something they can learn to do in a day. But it doesn’t work that way.”

She said the training is intensive and not everyone taking the course is successful.

Certificates are awarded to those that are successful.

“It is not something that ordinary people can do without training and even with training it must be done to certain specification or more harm than good can result.”

People receiving certificates in CPR must take a refresher course every six months, she said.

Certificates are awarded at different levels: basic rescuer, instructor and instructor-trainer.

Mrs. Reczuch said the foundation’s immediate goal is to provide instructor-trainers so more courses in CPR can be offered.

In addition to coordinating development of the program in Ontario, the foundation is responsible for reviewing and updating CPR standard, providing authorized teaching materials at cost to certified CPR instructors and establishing a central registry of all certified CPR instructors and instructor-trainers in Ontario.

(For more classic stories, check out our classic issues available for PDF download in our store: emsnews.com/shop/store)

Posted in From the Archives | Leave a comment

Reduce Stress At Work

If you have had difficulty in making decisions, not been able to concentrate, or having more accidents than usual, you could be at risk of extreme stress or even depression. And with the stress of responding to urgent and emergency situations as part of your daily work life, you could be even more at risk.

In honour of Mental Health Awareness Month, here are some tips to help you manage your stress on the job; while everyone experiences stress – and they should – not everyone copes with it in the same way. It`s important to know when you are feeling overly stressed, cope with it in a healthy way, and also to be proactive in handling the known stresses that you deal with each and every day.

Understand Stress
Everyone handles stress differently. By understanding your own reactions, you can effectively handle stress. Just a few things that can cause stress in our lives include:

  • Major events; getting married, changing jobs, moving your home, getting divorced, or coping with the loss of a loved one.
  • Long-term worries; concern about your children`s future, financial problems, or an ongoing illness.
  • Daily hassles; traffic jams, rude people, or technology.

As paramedics, with a high-stress job to begin with, it`s easy to see that several of the above can easily affect you.

Ways to Cope
While each of us is different and there is no one way to cope, there are a few things you can do and adjust to what works for you, according to the Canadian Mental Health Association.

  • Identify your problems. What is actually the issue
  • Solve your problems. This may seem straightforward, but often we don’t`even think about solutions clearly. Sit down, and think, how can I take care of this. Do I need counsellingÉ Should I talk to a professional financial expertÉ
  • Talk about your problems. You may find it helpful to talk to a friend or family member. Sometimes saying things out loud can show us a perspective we just didn`t see in our mind.
  • Learn about stress management. There are many counsellors or books, films or internet sources that you can easily access.
  • Reduce tension. Physical activity goes a long way. Even if you just get up and walk around for five minutes, you will notice reduced tension in your shoulders.
  • Take your mind off your problems. Get busy – having a hobby or sport to focus on regularly can ease your mind and let you look back with a renewed energy.

Get Help
If you have tried and not been able to reduce your stress, if you`re still losing sleep, making mistakes at work or perhaps `blowing up`at your partner, you should ask for help.

There are community services in your local area that can help you, such as the Canadian Mental Health Association, or your family doctor.

If you have recently experienced a traumatic situation, and feel you are having trouble coping, there are organizations dedicated especially to emergency services, such as the Tema Conter Memorial Trust.

Posted in Stress, Tools for on the job | Leave a comment

Potential Seen in Air Ambulance Growth

Image

Reprinted from the September-October 1978 Issue of Canadian Emergency Services News

A top-level confidential report prepared fro the B.C. cabinet has praised the B.C. air services branch as one of the country’s best-run organizations of its type, from an operations point of view.

At the same time the report, prepared by Gen. F. R. Sharp of P. S. Ross and Partners, a former chief of staff of the Canadian Armed Forces, says there are serious personnel problems in the organization’s top management and recommends a management shakeup.

There have been suggestions that use of the government air service is being abused, especially by ministers.

However, the Sharp report contradicts such suggestions.

“All aspects of the passenger carrying capacity appear to be extremely well organized and managed,” the report said. “The approval for flights is very sensibly controlled. Entitlement to fly as a passenger is restricted to those on government business (for example, no wives or dependents unless there are exceptional circumstances).

“This policy greatly reduces the chances for abuse in an activity that can easily get out of control, yet the policy generally meets the needs of the organizations served by the branch. Compared to other similar organizations, control over abuse is excellent.”

While giving the ASB top marks for the job it is now doing, the report predicts that its ambulance capability will have to be increased by 50 per cent over the next few years.

“As the air ambulance role is an essential role and will almost certainly increase, planning should be commenced to acquire aircraft which will meet the air ambulance role as a primary task and the medium and long-range transportation (of passengers) role as a secondary task,” the report said.

Highlights of the report include:

  • Safety procedures and safety record of the government air service is outstanding. “It is considered to be the best of all provincial air services.”
  • Maintenance standards are “extremely high” for the type of operation.
  • Training standards and the training program are of a high standard, though not all the training programs are being carried out because of other commitments. “This is not a dangerous situation, as more than the minimum required is being carried out,” the report states. “However, if the current high standard is to be maintained, more time will have to be allowed for training.” But while praising the standards of operations, the report said there is “need for changes in equipment, organization and branch management.” It is said the consequences of failing to react appropriately to “these emerging needs can be costly and in some cases, even dangerous.”

The report lists six points for immediate consideration.

Planning should start very soon on an equipment (aircraft) replacement program.

Accommodations at the government air terminals should be improved.

Air crew and maintenance establishments should be reviewed with a view to increasing the air crew and electronic and communications staff “slightly.”

The report said the two major corrective efforts needed are the “top management problem” and planning for acquisition of new equipment “if the current high calibre of operations is to continue.”

The report said the two Beech 18s cannot be used effectively and are up for disposal. It also recommends selling a third, modified Beech 18. It said the two Otter and Beaver aircraft will not be operable in a few years and some planning for their replacement should be undertaken.

It said the three Cessna Citation fanjets and the two Beech King Air 200s are good aircraft and, except for some unsuitability for ambulance service, are generally satisfactory. However, it said an increase in ambulance work in the future will require a different mix of aircraft.

The report said the King Airs are suitable for aerial photography as well as on the short Victoria and Vancouver runs and suggests a third King Air be acquired for that work.

The report said the Citations are “moderately suitable” for ambulance work and for medium-range transportation but are not suitable for short or long-range transportation.

The report notes that it would be both difficult and expensive to modify the doors for ambulance work and said planning for their replacement should also be begun.

“When planning for the replacement of the Citations, appropriate consideration should of course be given to the plans for new airstrips throughout the province and to plans for air ambulance and general health care,” the report said.

The report sets out a number of guidelines for replacing the present aircraft, which, it said, should be carried out as soon as possible.

It said policy for the air service branch should be defined along with a statement of the nature of the job anticipated for the service over the next five years. It should develop a statement as to necessary capabilities needed, including the type of aircraft, range, payload, speed, operational height and special equipment.

The report said specifications should be developed and bids called, with careful monitoring during the acquisition stage to ensure that specifications are being adhered to, to prevent “surprises (which can be costly and politically embarrassing.)”

In summary, the report said the ASB performs its task “with competence and safety and as efficiently as can be reasonably expected.”

(For more classic stories, check out our classic issues available for PDF download in our store: emsnews.com/shop/store)

Posted in Air Ambulance, From the Archives | Tagged , , , | Leave a comment

35 Years and Counting

The first issue of our print magazine, then called Canadian Emergency Services News, came off the press in July 1978. In the inagural message from staff member Erich Rast, prehospital care personnel are urged to “work towards improved emergency medical services for their communities.”  He also writes about frustrations encountered by ambulance personnel and the challenges of reaching political leaders in regard to emergency services issues. Much has changed since 1978, and some things haven’t.

What hasn’t changed, at least in regard to this publication, is what we stand for; to bring news, new products, developments in technique and exchange of opinion to paramedics.

This year we celebrate 35 years of bringing intriguing content to you. While our name has since changed twice, our values have not.

In celebration of 35 years, we bring you a newsletter that can fill the void between issues, and bring quick hits to you more often.

We bring you downloadable reprints of our classic issues, dating back to the inaugural issue in 1978.

We bring you a subscription contest that will send a lucky print subscriber to the far reaches of Vancouver Island for a wilderness trip of a lifetime.

Lastly, we would like to honour those of you who have also been in the business for 35 years. If you have or you know someone who has been practicing paramedicine for 35 years, please send us a note at cp@emsnews.com, and we will follow up and profile them so we can together, honour 35 years of paramedicine.

Posted in 35 years in publication, Uncategorized | Leave a comment